Provider Demographics
NPI:1558446526
Name:CONNOLLY, NATALIE (NP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3315
Mailing Address - Country:US
Mailing Address - Phone:630-315-6700
Mailing Address - Fax:630-315-6699
Practice Address - Street 1:552 RANDALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3315
Practice Address - Country:US
Practice Address - Phone:630-315-6700
Practice Address - Fax:630-315-6699
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004556363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01087504OtherRAILROAD MEDICARE PTAN (INDIVIDUAL)
IL920540014OtherMEDICARE PTAN (INDIVIDUAL)
ILCA4748OtherRAILROAD MEDICARE PTAN (GROUP)
IL920540OtherMEDICARE PTAN (GROUP)
ILP01087504OtherRAILROAD MEDICARE PTAN (INDIVIDUAL)