Individual
MARY LEE CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
724 SAWYER ST, SOUTH PORTLAND, ME 04106-4619
(207) 749-7942
Mailing address
724 SAWYER ST, SOUTH PORTLAND, ME 04106-4619
(207) 749-7942
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
AA
ME
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477044238
OPTUM VA
ME
Enumeration date
05/28/2018
Last updated
12/07/2020
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