Provider Demographics
NPI:1225307234
Name:CONNOLLY, MELINDA SUE (NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:SUE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER DR
Mailing Address - Street 2:RUBY MEMORIAL HOSPITAL - NICU
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-8110
Mailing Address - Country:US
Mailing Address - Phone:304-598-4140
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER DR
Practice Address - Street 2:RUBY MEMORIAL HOSPITAL - NICU
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-8110
Practice Address - Country:US
Practice Address - Phone:304-598-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV81403364SN0000X
PASP011793364SN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal