Provider Demographics
NPI:1033425889
Name:CONNOLLY, BERNADETTE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MARIE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RALEY BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8351
Mailing Address - Country:US
Mailing Address - Phone:530-342-5776
Mailing Address - Fax:530-898-0178
Practice Address - Street 1:111 RALEY BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8351
Practice Address - Country:US
Practice Address - Phone:530-342-5776
Practice Address - Fax:530-898-0178
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15067363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical