Provider Demographics
NPI:1003105156
Name:CODDINGTON, CONNIE HAYS
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:HAYS
Last Name:CODDINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 CLUB CIR
Mailing Address - Street 2:SUITE NUMBER 307N
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6981
Mailing Address - Country:US
Mailing Address - Phone:262-785-6789
Mailing Address - Fax:
Practice Address - Street 1:1165 CLUB CIR
Practice Address - Street 2:SUITE NUMBER 307N
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6981
Practice Address - Country:US
Practice Address - Phone:262-785-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner