Provider Demographics
NPI:1528376258
Name:LARD, CONNIE (CRNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:LARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MONROE ST
Mailing Address - Street 2:SUITE 1386
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-3735
Mailing Address - Country:US
Mailing Address - Phone:334-206-7959
Mailing Address - Fax:334-206-3998
Practice Address - Street 1:4112 CHISHOLM RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-7345
Practice Address - Country:US
Practice Address - Phone:256-764-7453
Practice Address - Fax:256-764-4185
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-029021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily