Individual
MRS. LAURA LEE CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3 WESTBROOK CORPORATE CTR, STE 1000, WESTCHESTER, IL 60154-5703
(708) 343-3566
(708) 343-9235
Mailing address
3 WESTBROOK CORPORATE CTR, STE 1000, WESTCHESTER, IL 60154-5703
(708) 343-3566
(708) 343-9235
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085002150
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085002150
—
IL
Enumeration date
04/28/2006
Last updated
11/16/2009
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