Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209010957 | IL |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 209.010957 | IL |
NPI | 1003247511 |
---|---|
Provider Name | Deborah Saylor Connell |
First Address | Christopher, IL 62822-0155 |
Second Address | Christopher, IL 62822-1037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2013 |
Last Update Date | 18/11/2015 |