Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD60424676 | WA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD60424676 | WA |
NPI | 1194024448 |
---|---|
Provider Name | Camille Lauren Connelly |
First Address | Seattle, WA 98104-1172 |
Second Address | Mount Vernon, WA 98273-4105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2011 |
Last Update Date | 17/03/2018 |