Provider Demographics
NPI:1699965533
Name:KONOMOS, WENDI E (GNP)
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:E
Last Name:KONOMOS
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 LANDA ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6114
Mailing Address - Country:US
Mailing Address - Phone:210-614-8612
Mailing Address - Fax:210-615-5596
Practice Address - Street 1:774 LANDA ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6114
Practice Address - Country:US
Practice Address - Phone:830-625-0305
Practice Address - Fax:830-625-0298
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX611930363LG0600X
TXAP115952363LG0600X
TXR24960363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1G9356OtherMEDICARE
TXP02569432OtherMEDICARE RAILROAD