Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | ||
Y | 176B00000X | Midwife | 25ME00016101 | NJ |
N | 176B00000X | Midwife | F000634-1 | NY |
NPI | 1942446893 |
---|---|
Provider Name | Ms. Patricia Mary Connolly-Detura |
First Address | Bergenfield, NJ 07621-3024 |
Second Address | Bergenfield, NJ 07621-3024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2008 |
Last Update Date | 12/09/2013 |