Provider Demographics
NPI:1043336761
Name:CONNOLLY, MAUREEN ANNE (RNC, ANP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANNE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:RNC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 UPLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-2002
Mailing Address - Country:US
Mailing Address - Phone:617-964-6808
Mailing Address - Fax:617-964-6809
Practice Address - Street 1:303 UPLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-2002
Practice Address - Country:US
Practice Address - Phone:617-964-6808
Practice Address - Fax:617-964-6809
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164581363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health