Individual
MRS. STEPHANIE NOELLE CONNELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2577 MAIN AVE, DURANGO, CO 81301
(970) 247-8382
(970) 259-4403
Mailing address
17700 E 39TH ST S, INDEPENDENCE, MO 64055-6725
(163) 930-2508
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
022356-1
NY
363A00000X
Physician Assistant
Primary
15-02568
KS
363A00000X
Physician Assistant
2018017096
MO
363AM0700X
Medical Physician Assistant
PA.0005871
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
07/27/2018
Last updated
02/10/2022
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