Provider Demographics
NPI:1619004884
Name:BEMIS, CONNI ANN (SERVICE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:CONNI
Middle Name:ANN
Last Name:BEMIS
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 OXEN RD SE
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:KS
Mailing Address - Zip Code:66857-9437
Mailing Address - Country:US
Mailing Address - Phone:620-364-8714
Mailing Address - Fax:620-364-8714
Practice Address - Street 1:590 OXEN RD SE
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:KS
Practice Address - Zip Code:66857-9437
Practice Address - Country:US
Practice Address - Phone:620-364-8714
Practice Address - Fax:620-364-8714
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator