Healthcare Provider Details

I. General information

NPI: 1003042086
Provider Name (Legal Business Name): CONNIE MAURINE DRISKELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE STOLL

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

IV. Provider business mailing address

4353 E COLFAX AVE
DENVER CO
80220-1115
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6509
  • Fax: 303-782-0916
Mailing address:
  • Phone: 303-504-1200
  • Fax: 303-320-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number71121
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: