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NPI Code Detail

MEDICARE: KIM LEA CONNELLY

MEDICARE: KIM LEA CONNELLY
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
1163W00000XRegistered Nurse123148-30WI

General Provider Information

NPI Number : 1326661323
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM LEA CONNELLY
Provider Business Mailing Address
First Line : 2276 DOLLAR RD
Second Line :
City : DE PERE
State : WI
Zip : 54115-9712
Country : US
Telephone Number : 920-737-3601
Fax Number :
Provider Business Practice Location Address
First Line : 1700 CHICAGO ST
Second Line :
City : DE PERE
State : WI
Zip : 54115-3418
Country : US
Telephone Number : 920-337-1032
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2020
Last Update Date : 05/26/2020

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Directions to “ KIM LEA CONNELLY ” Practice Location

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