Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | WV2727 | WV |
NPI | 1073629135 |
---|---|
Provider Name | Dr. Catherine E Conner |
First Address | Bridgeport, WV 26330-1353 |
Second Address | Bridgeport, WV 26330-1353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |