Healthcare Provider Details

I. General information

NPI: 1144728155
Provider Name (Legal Business Name): EUPHEMIA M CONNELL DNP, APRN, ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

V. Phone/Fax

Practice location:
  • Phone: 773-926-9147
  • Fax: 773-702-8690
Mailing address:
  • Phone: 773-926-9147
  • Fax: 773-702-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209006089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: