Provider Demographics
NPI:1134322191
Name:CONN, CAROLE WALSH (RN CCM)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:WALSH
Last Name:CONN
Suffix:
Gender:F
Credentials:RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 COACHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5035
Mailing Address - Country:US
Mailing Address - Phone:724-746-9616
Mailing Address - Fax:724-746-3052
Practice Address - Street 1:115 COACHSIDE DR
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-5035
Practice Address - Country:US
Practice Address - Phone:724-746-9616
Practice Address - Fax:724-746-3052
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN193926171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator