Provider Demographics
NPI:1184656472
Name:CONNELL, PATRICIA MARY (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARY
Last Name:CONNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MARY
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04574-0348
Mailing Address - Country:US
Mailing Address - Phone:207-845-3022
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - Street 2:IVACTR
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-9929
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-621-4892
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME46763363L00000X
MA98315363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner