1902925266 NPI number — MS. KARIN SUE CONNOLLY ADULT NURSE PRACTITI

Table of content: MS. KARIN SUE CONNOLLY ADULT NURSE PRACTITI (NPI 1902925266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902925266 NPI number — MS. KARIN SUE CONNOLLY ADULT NURSE PRACTITI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONNOLLY
Provider First Name:
KARIN
Provider Middle Name:
SUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ADULT NURSE PRACTITI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902925266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6439 GARNERS FERRY RD.
Provider Second Line Business Mailing Address:
(WM, JENNINGS BRYAN DORN VAMC)
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-776-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45428-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-891-3100
Provider Business Practice Location Address Fax Number:
513-487-6052
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0200X , with the licence number:  143132 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: ARNP9283958 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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