Individual
DR. CHRISTINE A CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
602 N 6TH STREET WEST, CHEYENNE WELLS, CO 80810-0578
(719) 767-5669
(719) 767-8042
Mailing address
602 N 6TH STREET WEST, CHEYENNE WELLS, CO 80810-0578
(719) 767-5669
(719) 767-8042
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41473
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29639522
—
CO
01
—
COA106508
MEDICARE PTAN
CO
Enumeration date
11/16/2005
Last updated
01/06/2014
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