Individual
DIANA CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
12000 STONE LAKE ROAD, DULCE, NM 87528-0187
(505) 759-3291
Mailing address
PO BOX 187, DULCE, NM 87528-0187
(505) 759-3291
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
179402
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
06/05/2008
Last updated
06/05/2008
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