Provider Demographics
NPI:1811299266
Name:KONZ, SHANNA LYNN (CNP)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:LYNN
Last Name:KONZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:LYNN
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-4907
Mailing Address - Country:US
Mailing Address - Phone:605-521-5116
Mailing Address - Fax:
Practice Address - Street 1:421 8TH ST S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-4907
Practice Address - Country:US
Practice Address - Phone:605-782-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000626363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner