Provider Demographics
NPI:1558904508
Name:CONNELL-DENT, DEBRA J (APN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:CONNELL-DENT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 GRAHAM RD STE C-2320
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8030
Mailing Address - Country:US
Mailing Address - Phone:314-953-6801
Mailing Address - Fax:
Practice Address - Street 1:1225 GRAHAM RD STE C-2320
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8030
Practice Address - Country:US
Practice Address - Phone:314-953-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019024738363L00000X
IL209019906363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily