Healthcare Provider Details

I. General information

NPI: 1245166222
Provider Name (Legal Business Name): STACI ANNE CONNOLLY CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACI ANNE HEWITSON

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9780 S MCCARRAN BLVD APT 1
RENO NV
89523-9203
US

IV. Provider business mailing address

9780 S MCCARRAN BLVD APT 1
RENO NV
89523-9203
US

V. Phone/Fax

Practice location:
  • Phone: 775-404-5000
  • Fax: 775-384-6172
Mailing address:
  • Phone: 775-404-5000
  • Fax: 775-384-6172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC75
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: