Provider Demographics
NPI:1316062771
Name:KONZ, ALYCE LORAYNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ALYCE
Middle Name:LORAYNE
Last Name:KONZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HILLCREST AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3680
Mailing Address - Country:US
Mailing Address - Phone:507-541-0290
Mailing Address - Fax:507-451-0291
Practice Address - Street 1:304 BELLE AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5250
Practice Address - Country:US
Practice Address - Phone:507-344-8698
Practice Address - Fax:507-344-8759
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL011383-2164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse