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General NPI Number Information
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NPI Number | 1497193882
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Entity Type | Individual
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Provider Name | LATONYA ROCHELLE CONNALLY RN
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Gender | Female
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 11447 JOS CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3040
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Country | US
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Telephone | 313-365-1368
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Fax |
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Provider Business Mailing Address
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Address Line | 325 MOROSS RD
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City | GROSSE POINTE FARMS
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State | MI
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Zip | 48236-2911
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Country | US
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Telephone | 313-886-3870
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704270676
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 4704270676
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 4704270676
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License Number State | MI
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