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NPI Code Detail

MEDICARE: RENEE E CONNOLLY APRN, BC

MEDICARE: RENEE E CONNOLLY APRN, BC
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
1363LG0600XGerontology Nurse PractitionerSP001461HPA
2363L00000XNurse PractitionerSP001461HPA

General Provider Information

NPI Number : 1538293568
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE E CONNOLLY APRN, BC
Provider Business Mailing Address
First Line : 6950 GERMANTOWN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-2120
Country : US
Telephone Number : 215-951-4400
Fax Number :
Provider Business Practice Location Address
First Line : 6950 GERMANTOWN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-2120
Country : US
Telephone Number : 215-951-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 05/02/2016

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Directions to “ RENEE E CONNOLLY APRN, BC” Practice Location

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