Provider Demographics
NPI:1275846461
Name:CONNOLLY, NANCY ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ELIZABETH
Other - Last Name:BROWN CONNOLLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:65 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3146
Mailing Address - Country:US
Mailing Address - Phone:805-258-4665
Mailing Address - Fax:
Practice Address - Street 1:1270 65TH PL
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5764
Practice Address - Country:US
Practice Address - Phone:805-258-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR99124163W00000X, 163WC0200X, 163WC1500X, 163WH0200X, 163WM0102X, 163WP1700X
1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No1744R1102XOther Service ProvidersSpecialistResearch Study