Healthcare Provider Details

I. General information

NPI: 1326334087
Provider Name (Legal Business Name): MARIE T CONNER CNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 INDUSTRIAL PKWY E
EL DORADO SPRINGS MO
64744-6263
US

IV. Provider business mailing address

1301 INDUSTRIAL PKWY E
EL DORADO SPRINGS MO
64744-6263
US

V. Phone/Fax

Practice location:
  • Phone: 417-448-1021
  • Fax: 417-876-1069
Mailing address:
  • Phone: 417-448-1021
  • Fax: 417-876-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number2010009924
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: