Healthcare Provider Details

I. General information

NPI: 1124212113
Provider Name (Legal Business Name): ANDREA JOY CONNORS DNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2007
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10280 BEMIS RD
WILLIS MI
48191-9742
US

IV. Provider business mailing address

25 OWEN ST
BELLEVILLE MI
48111-2921
US

V. Phone/Fax

Practice location:
  • Phone: 734-699-5400
  • Fax: 734-699-5455
Mailing address:
  • Phone: 734-699-5400
  • Fax: 734-699-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704239544
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: