Individual
MARY SUSAN CONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
4331 S FREMONT AVE, SPRINGFIELD, MO 65804-7328
(417) 820-5000
(417) 820-5025
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
058838
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205822
MO BLUE SHIELD
MO
01
—
83416
ARK BLUE SHIELD
AR
Enumeration date
02/08/2007
Last updated
07/08/2007
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