Individual
COURTNEY CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14502 W MEEKER BLVD, BANNER DEL E. WEBB EMERGENCY DEPT, SUN CITY WEST, AZ 85375-5282
(623) 524-4067
(623) 524-4182
Mailing address
14502 W MEEKER BLVD, BANNER DEL E. WEBB EMERGENCY DEPT, SUN CITY WEST, AZ 85375-5282
(623) 524-4067
(623) 524-4182
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6176
AZ
390200000X
Student in an Organized Health Care Education/Training Program
27-1369141
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN PROCESS
THE MUTUAL
AZ
Enumeration date
07/22/2015
Last updated
08/31/2016
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