Healthcare Provider Details

I. General information

NPI: 1891909347
Provider Name (Legal Business Name): MARY CONNELLY RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HOSPITAL CIRCLE
BROWNING MT
59417
US

IV. Provider business mailing address

760 HOSPITAL CIRCLE
BROWNING MT
59417
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-6231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN401001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: