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General NPI Number Information
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NPI Number | 1114319746
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Entity Type | Individual
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Provider Name | CONNIE MARIE SYROPOULOS NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 922 W BAXTER DR STE 1110
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8613
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Country | US
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Telephone | 385-281-9846
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Fax |
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Provider Business Mailing Address
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Address Line | 30625 MARTINDALE RD APT 106
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City | NEW HUDSON
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State | MI
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Zip | 48165-9839
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Country | US
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Telephone | 313-204-7544
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Fax | 629-837-5940
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 217324
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 12218275-4405
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License Number State | UT
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