Individual
CAROLINE L CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
691 MURPHY RD, SUITE 107, MEDFORD, OR 97504-4346
(541) 789-6460
(541) 789-6461
Mailing address
2620 E BARNETT RD, SUITE H, MEDFORD, OR 97504-8344
(541) 789-8176
(541) 789-2558
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201020177NP
OR
363LF0000X
Family Nurse Practitioner
Primary
201050177NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500629732
—
OR
Enumeration date
09/16/2010
Last updated
10/13/2015
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