Healthcare Provider Details

I. General information

NPI: 1609914076
Provider Name (Legal Business Name): COLIN L CONNER R.N., MS, PNP-BC,CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CAMBRIDGE AVE SUITE 301
PHOENIX AZ
85006-1459
US

IV. Provider business mailing address

1920 E CAMBRIDGE AVE STE 301
PHOENIX AZ
85006-1464
US

V. Phone/Fax

Practice location:
  • Phone: 602-689-8684
  • Fax: 602-256-2878
Mailing address:
  • Phone: 602-689-8684
  • Fax: 602-256-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP3833
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number561332
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberRN052285
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: