Healthcare Provider Details

I. General information

NPI: 1710919808
Provider Name (Legal Business Name): DEBORAH J. CONNOLLY PCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

8167 ANCHOR POINT DR
RENO NV
89506-3147
US

IV. Provider business mailing address

PO BOX 60610
RENO NV
89506-0012
US

V. Phone/Fax

Practice location:
  • Phone: 775-971-9193
  • Fax: 775-971-9193
Mailing address:
  • Phone: 775-971-9193
  • Fax: 775-971-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number90143
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: