Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 60260849 | WA |
NPI | 1023291911 |
---|---|
Provider Name | Mrs. Desiree Rose Connelly |
First Address | Bellevue, WA 98005 |
Second Address | Seattle, WA 98104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 17/03/2014 |