Provider Demographics
NPI:1083717243
Name:INMAN, CONNIE LYNN
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:LYNN
Last Name:INMAN
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 1:1605 MADISON 535
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-8373
Mailing Address - Country:US
Mailing Address - Phone:573-546-2546
Mailing Address - Fax:
Practice Address - Street 1:128 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-1313
Practice Address - Country:US
Practice Address - Phone:573-546-3434
Practice Address - Fax:573-546-3006
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide