Healthcare Provider Details

I. General information

NPI: 1083717243
Provider Name (Legal Business Name): CONNIE LYNN INMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W RUSSELL ST
IRONTON MO
63650-1313
US

IV. Provider business mailing address

1605 MADISON 535
FREDERICKTOWN MO
63645-8373
US

V. Phone/Fax

Practice location:
  • Phone: 573-546-3434
  • Fax: 573-546-3006
Mailing address:
  • Phone: 573-546-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: