Provider Demographics
NPI:1023559093
Name:CONNOR, EMMALIE BLISS (APRN)
Entity Type:Individual
Prefix:
First Name:EMMALIE
Middle Name:BLISS
Last Name:CONNOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EMMALIE
Other - Middle Name:BLISS
Other - Last Name:NORRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 412503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2503
Mailing Address - Country:US
Mailing Address - Phone:617-726-3884
Mailing Address - Fax:
Practice Address - Street 1:19 OLD ROLLINSFORD RD BLDG B
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2807
Practice Address - Country:US
Practice Address - Phone:603-516-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2285154363LA2100X
NH086471-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3131690Medicaid