MEDICARE: MS. BARBARA C CONNELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	0024031031	VA

General Provider Information

NPI Number	:	1013917830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA C CONNELL

Provider Business Mailing Address
First Line	:	1916 WOODBERRY MILL RD
Second Line	:
City	:	POWHATAN
State	:	VA
Zip	:	23139-5300
Country	:	US
Telephone Number	:	804-794-8525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 WOODBERRY MILL RD
Second Line	:
City	:	POWHATAN
State	:	VA
Zip	:	23139-5300
Country	:	US
Telephone Number	:	804-794-8525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/29/2012

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