Individual
CHRISTINA CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2640 HAMSTROM RD, PORTAGE, IN 46368-3832
(219) 762-4423
Mailing address
2640 HAMSTROM RD, PORTAGE, IN 46368-3832
(219) 762-4423
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71006279A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71006279A
APN
IN
01
—
71006279B
CSR
IN
Enumeration date
06/01/2016
Last updated
11/03/2017
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