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General NPI Number Information
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NPI Number | 1770482002
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Entity Type | Individual
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Provider Name | LISA CONNELLY RN; LSN
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Gender | Female
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 1200 W DOROTHY LN
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City | KETTERING
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State | OH
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Zip | 45409-1307
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Country | US
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Telephone | 937-499-1890
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Fax | 937-499-1890
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Provider Business Mailing Address
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Address Line | 1200 W DOROTHY LN
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City | KETTERING
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State | OH
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Zip | 45409-1307
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Country | US
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Telephone | 937-499-1890
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Fax | 937-499-1909
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 207900
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License Number State | OH
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