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General NPI Number Information
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NPI Number | 1790093391
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Entity Type | Individual
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Provider Name | CAROLINE L CONNELLY FNP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 691 MURPHY RD SUITE 107
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City | MEDFORD
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State | OR
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Zip | 97504-4346
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Country | US
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Telephone | 541-789-6460
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Fax | 541-789-6461
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Provider Business Mailing Address
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Address Line | 2620 E BARNETT RD SUITE H
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City | MEDFORD
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State | OR
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Zip | 97504-8344
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Country | US
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Telephone | 541-789-8176
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Fax | 541-789-2558
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201050177NP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201020177NP
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License Number State | OR
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