MEDICARE: MRS. KATHERINE LOVGREN CONNELLY F.N.P.

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	363LF0000X	Family Nurse Practitioner	340567	NY

General Provider Information

NPI Number	:	1063957363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE LOVGREN CONNELLY F.N.P.

Provider Business Mailing Address
First Line	:	5008 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3324
Country	:	US
Telephone Number	:	718-283-8978
Fax Number	:	718-635-8949

Provider Business Practice Location Address
First Line	:	5008 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3324
Country	:	US
Telephone Number	:	718-283-8978
Fax Number	:	718-635-8949

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

Provider Enumeration Date	:	12/23/2016
Last Update Date	:	12/23/2016

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