Individual
MARILYN F CONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CANP
Contact information
Practice address
82 MIDDLE COUNTRY ROAD, THE ELSIE OWENS N BROOKHAVEN HEALTH CENTER AT CORAM, CORAM, NY 11727
(631) 854-2301
(631) 854-2104
Mailing address
75 N COUNTRY RD, JOHN T MATHER HOSPITAL, PORT JEFFERSON, NY 11777-2119
(631) 476-2715
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F3007001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01770245
—
NY
Enumeration date
09/08/2006
Last updated
06/13/2013
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