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General NPI Number Information
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NPI Number | 1013906163
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Entity Type | Individual
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Provider Name | MARY VICTORIA CONNERS NP
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Gender | Female
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 630 BROADWAY ST
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City | MADISON
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State | IN
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Zip | 47250
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Country | US
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Telephone | 812-801-0338
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Fax | 812-801-0777
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Provider Business Mailing Address
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Address Line | PO BOX 3395
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City | EVANSVILLE
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State | IN
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Zip | 47732-3395
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71001571A
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License Number State | IN
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