Healthcare Provider Details

I. General information

NPI: 1275846461
Provider Name (Legal Business Name): NANCY ELIZABETH CONNOLLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY ELIZABETH BROWN CONNOLLY RN

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 65TH PL
WEST DES MOINES IA
50266-5764
US

IV. Provider business mailing address

65 SHAMROCK DR
VENTURA CA
93003-3146
US

V. Phone/Fax

Practice location:
  • Phone: 805-258-4665
  • Fax:
Mailing address:
  • Phone: 805-258-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR99124
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR99124
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR99124
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR99124
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberR99124
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberR99124
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: