Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 642405 | TX |
NPI | 1063478881 |
---|---|
Provider Name | Lynne Connelly |
First Address | Richardson, TX 75082-3542 |
Second Address | Richardson, TX 75082-3542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
642405 | LICENSE (01) | TX |