Provider Demographics
NPI:1598479438
Name:CONNOVICH, FAITH MADELINE (CNP)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:MADELINE
Last Name:CONNOVICH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 DAYTON XENIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-4310
Mailing Address - Country:US
Mailing Address - Phone:937-531-7902
Mailing Address - Fax:
Practice Address - Street 1:3095 DAYTON XENIA RD STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-4310
Practice Address - Country:US
Practice Address - Phone:937-531-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily