Healthcare Provider Details

I. General information

NPI: 1285059253
Provider Name (Legal Business Name): DENISE CONNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2838 W MAIN ST
MEDFORD OR
97501-2405
US

IV. Provider business mailing address

931 CHEVY WAY
MEDFORD OR
97504-4127
US

V. Phone/Fax

Practice location:
  • Phone: 541-842-3415
  • Fax: 541-842-3774
Mailing address:
  • Phone: 541-535-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number201503500RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: