Individual
DETTA CONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHLEBOTOMIST
Contact information
Practice address
2348 KINMERE DR, GASTONIA, NC 28056-7812
(704) 674-4935
Mailing address
2348 KINMERE DR, GASTONIA, NC 28056-7812
(704) 674-4935
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
4-6287
NC
Other
Enumeration date
12/13/2023
Last updated
12/13/2023
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