Individual
MARY A CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1580 COMMANCHE AVE, GREEN BAY, WI 54313-5751
(920) 445-7295
Mailing address
1580 COMMANCHE AVE, GREEN BAY, WI 54313-5751
(920) 445-7295
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33056
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33056
LICENSE
WI
Enumeration date
12/05/2005
Last updated
02/27/2014
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