Provider Demographics
NPI:1700604584
Name:KONN, CARRIE (FNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:KONN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BONALIFE
Other - Middle Name:
Other - Last Name:PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8940 WILLOW TRACE CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-6807
Mailing Address - Country:US
Mailing Address - Phone:203-521-2447
Mailing Address - Fax:
Practice Address - Street 1:916 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1512
Practice Address - Country:US
Practice Address - Phone:919-782-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily