Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101255914 | VA |
NPI | 1013235936 |
---|---|
Provider Name | Colleen M Connor |
First Address | Virginia Beach, VA 23462-7958 |
Second Address | Virginia Beach, VA 23462-7958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 19/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101255914 | LICENSE (01) | VA |