Provider Demographics
NPI:1326409152
Name:CONNELLY, ANDREA KRISTIN (RN, MSN, CPNP-AC)
Entity Type:Individual
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First Name:ANDREA
Middle Name:KRISTIN
Last Name:CONNELLY
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Gender:F
Credentials:RN, MSN, CPNP-AC
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Mailing Address - Street 1:3701 WILSHIRE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2814
Mailing Address - Country:US
Mailing Address - Phone:323-361-3550
Mailing Address - Fax:323-361-8052
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAIL STOP 66
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-4148
Practice Address - Fax:323-361-3668
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2017-12-06
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Provider Licenses
StateLicense IDTaxonomies
CA95003749363LP0222X, 363LP0200X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology