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General NPI Number Information
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NPI Number | 1578073946
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Entity Type | Individual
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Provider Name | PEGE CONNOLLY
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Gender | Female
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 317 IRENE AVE.
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City | IRONTON
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State | MN
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Zip | 56455
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Country | US
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Telephone | 218-546-6242
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Fax | 218-772-0142
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Provider Business Mailing Address
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Address Line | 317 IRENE AVE. P.O. BOX 1
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City | IRONTON
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State | MN
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Zip | 56455
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Country | US
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Telephone | 218-546-6242
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Fax | 218-772-0142
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | R-107553-9
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License Number State | MN
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