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General NPI Number Information
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NPI Number | 1710192224
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Entity Type | Individual
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Provider Name | SALLY A CONNAUGHTON
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 3322 COLORADO BLVD SUITE 101
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City | DENTON
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State | TX
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Zip | 76210-6864
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Country | US
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Telephone | 940-387-7588
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Fax | 940-566-0881
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Provider Business Mailing Address
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Address Line | 3322 COLORADO BLVD SUITE 101
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City | DENTON
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State | TX
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Zip | 76210-6864
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Country | US
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Telephone | 940-387-7588
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Fax | 940-566-0881
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 104146
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License Number State | TX
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