Healthcare Provider Details

I. General information

NPI: 1992753065
Provider Name (Legal Business Name): STACEY ANN CONNELL APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218A DELAWARE AVENUE
PALMERTON PA
18071
US

IV. Provider business mailing address

1605 N CEDAR CREST BLVD STE 110B
ALLENTOWN PA
18104-2351
US

V. Phone/Fax

Practice location:
  • Phone: 610-826-6353
  • Fax: 610-826-6359
Mailing address:
  • Phone: 610-973-1410
  • Fax: 610-973-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP008731
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: