Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26RN01698900 | NJ |
NPI | 1013111947 |
---|---|
Provider Name | Mrs. Kathleen Ann Connolly |
First Address | North Haledon, NJ 07508-2716 |
Second Address | Paterson, NJ 07501-2815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 08/07/2007 |