Individual
CAROL CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
407 S SCHWARTZ AVE, STE 102, FARMINGTON, NM 87401-5925
(505) 609-6700
(505) 609-6701
Mailing address
PO BOX 6210, FARMINGTON, NM 87499-6210
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R39967
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000Z0447
—
NM
Enumeration date
10/02/2006
Last updated
04/10/2013
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