Healthcare Provider Details

I. General information

NPI: 1043299191
Provider Name (Legal Business Name): CONNIE ANN NEAL RN, MSN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE ANN WINGROVE

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 N GILBERT RD SUITE D-160
GILBERT AZ
85234-4591
US

IV. Provider business mailing address

459 N GILBERT RD SUITE D-160
GILBERT AZ
85234-4591
US

V. Phone/Fax

Practice location:
  • Phone: 480-539-8680
  • Fax: 480-539-1763
Mailing address:
  • Phone: 480-539-8680
  • Fax: 480-539-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN071893
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: