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General NPI Number Information
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NPI Number | 1679835987
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Entity Type | Organization
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Legal Business Name | VIRGINIA LEA CONNER PLLC
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 141 S MCCORMICK ST STE 109
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City | PRESCOTT
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State | AZ
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Zip | 86303-4730
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Country | US
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Telephone | 928-710-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 141 S MCCORMICK ST STE 109
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City | PRESCOTT
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State | AZ
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Zip | 86303-4730
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Country | US
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Telephone | 928-710-8800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIRGINIA LEA CONNER
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Credential | MD
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Telephone | 928-710-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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