Provider Demographics
NPI:1114319746
Name:SYROPOULOS, CONNIE MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:SYROPOULOS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:MARIE
Other - Last Name:ST. LAURENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1115 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1323
Mailing Address - Country:US
Mailing Address - Phone:801-485-1035
Mailing Address - Fax:801-606-7333
Practice Address - Street 1:1115 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-1323
Practice Address - Country:US
Practice Address - Phone:801-485-1035
Practice Address - Fax:801-606-7333
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021522363LA2200X
UT12218275-4405363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health