Provider Demographics
NPI:1710919808
Name:CONNOLLY, DEBORAH J (PCA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60610
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-0012
Mailing Address - Country:US
Mailing Address - Phone:775-971-9193
Mailing Address - Fax:775-971-9193
Practice Address - Street 1:8167 ANCHOR POINT DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-3147
Practice Address - Country:US
Practice Address - Phone:775-971-9193
Practice Address - Fax:775-971-9193
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV90143374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide