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General NPI Number Information
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NPI Number | 1063184968
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Entity Type | Individual
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Provider Name | CONNOR REZZONICO PMHNP
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Gender | Male
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 1110 W PARK PL STE 222
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2784
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Country | US
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Telephone | 208-625-7695
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Fax | 949-864-3567
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Provider Business Mailing Address
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Address Line | 1110 W PARK PL STE 222
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2784
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Country | US
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Telephone | 208-625-7695
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Fax | 949-864-3597
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP70005328
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 74368
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License Number State | ID
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