Provider Demographics
NPI:1972626596
Name:KONOSKE, TRACY LYNN (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:KONOSKE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BUS LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-9214
Mailing Address - Country:US
Mailing Address - Phone:406-534-9405
Mailing Address - Fax:406-333-7190
Practice Address - Street 1:71 BUS LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-9214
Practice Address - Country:US
Practice Address - Phone:406-534-9405
Practice Address - Fax:406-333-7190
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered