Healthcare Provider Details

I. General information

NPI: 1881642262
Provider Name (Legal Business Name): AMY CONNORS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 BARNES BLVD MCCHORD FIELD
JOINT BASE LEWIS MCCHORD WA
98438-1303
US

IV. Provider business mailing address

690 BARNES BLVD MCCHORD FIELD
JOINT BASE LEWIS MCCHORD WA
98438-1303
US

V. Phone/Fax

Practice location:
  • Phone: 253-982-0328
  • Fax: 253-982-2339
Mailing address:
  • Phone: 253-982-0328
  • Fax: 253-982-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01046891A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: