Provider Demographics
NPI:1679835987
Name:VIRGINIA LEA CONNER PLLC
Entity Type:Organization
Organization Name:VIRGINIA LEA CONNER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-710-8800
Mailing Address - Street 1:141 S MCCORMICK ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4730
Mailing Address - Country:US
Mailing Address - Phone:928-710-8800
Mailing Address - Fax:
Practice Address - Street 1:141 S MCCORMICK ST STE 109
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4730
Practice Address - Country:US
Practice Address - Phone:928-710-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty