Individual
NATALIE CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
552 RANDALL RD, SOUTH ELGIN, IL 60177-3315
(630) 315-6700
(630) 315-6699
Mailing address
552 RANDALL RD, SOUTH ELGIN, IL 60177-3315
(630) 315-6700
(630) 315-6699
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209004556
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
920540014
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
RAILROAD MEDICARE PTAN (GROUP)
IL
01
—
P01087504
RAILROAD MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
10/26/2006
Last updated
04/02/2013
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