Individual
MRS. PERRI CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11311 BRIDGEPORT WAY SW, SUITE 100, LAKEWOOD, WA 98499-3071
(253) 985-6699
Mailing address
2441B S 10TH ST, JOINT BASE LEWIS MCCHORD, WA 98433-1030
(585) 797-8932
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8943623
MEDICARE
—
Enumeration date
01/05/2015
Last updated
11/16/2015
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