Provider Demographics
NPI:1346857992
Name:CONNELLY, MARY RACHEL (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RACHEL
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7753
Mailing Address - Fax:843-777-7754
Practice Address - Street 1:101 WILLIAM H JOHNSON ST STE 270
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2763
Practice Address - Country:US
Practice Address - Phone:843-777-7753
Practice Address - Fax:843-777-7754
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006483363LF0000X
SC25826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily