Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 68491 | AZ |
NPI | 1114972783 |
---|---|
Provider Name | Mrs. Mary Olsen Connelly |
First Address | Tucson, AZ 85719-3747 |
Second Address | Tucson, AZ 85712-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 18/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
937295 | (05) | AZ |