MEDICARE: MRS. CONNIE L PARR APN, CPNP

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	363LP0200X	Pediatric Nurse Practitioner	209000942	IL

General Provider Information

NPI Number	:	1437274651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE L PARR APN, CPNP

Provider Business Mailing Address
First Line	:	4580 WEAVER PARKWAY
Second Line	:	SUITE 204
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-3864
Country	:	US
Telephone Number	:	630-473-3970
Fax Number	:	630-994-5028

Provider Business Practice Location Address
First Line	:	4580 WEAVER PKWY STE 204
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-3864
Country	:	US
Telephone Number	:	630-473-3970
Fax Number	:	630-994-5028

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/21/2022

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