Provider Demographics
NPI:1255664934
Name:WALDEN, CONNIE S (RN BSN CLC)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:S
Last Name:WALDEN
Suffix:
Gender:F
Credentials:RN BSN CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 UTAH AVE.
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:67740-0955
Mailing Address - Country:US
Mailing Address - Phone:785-675-2121
Mailing Address - Fax:785-675-2193
Practice Address - Street 1:1125 UTAH AVE.
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:KS
Practice Address - Zip Code:67740-0955
Practice Address - Country:US
Practice Address - Phone:785-675-2121
Practice Address - Fax:785-675-2193
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-66690-111163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management