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General NPI Number Information
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NPI Number | 1205452075
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Entity Type | Individual
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Provider Name | PATRICIA EILEEN CONNELLY L.AC
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Gender | Female
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 6426 S MCCLINTOCK DR STE 110
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City | TEMPE
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State | AZ
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Zip | 85283-3954
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Country | US
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Telephone | 602-888-0216
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Fax |
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Provider Business Mailing Address
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Address Line | 3730 S MILL AVE APT G112
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City | TEMPE
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State | AZ
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Zip | 85282-8322
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Country | US
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Telephone | 480-452-2493
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | LAC-010093
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License Number State | AZ
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