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General NPI Number Information
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NPI Number | 1144604943
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Entity Type | Individual
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Provider Name | THOMAS MCCONNELL NP
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Gender | Male
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 2025 FORD AVE STE 100
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City | WYANDOTTE
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State | MI
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Zip | 48192-2301
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Country | US
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Telephone | 734-281-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 GOLDEN LN
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City | YPSILANTI
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State | MI
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Zip | 48198-3657
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Country | US
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Telephone | 734-482-8238
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704264062
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License Number State | MI
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