Provider Demographics
NPI:1760565758
Name:MCCONNELL, DEANNA JEAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:JEAN
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W EAST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2002
Mailing Address - Country:US
Mailing Address - Phone:530-896-9400
Mailing Address - Fax:530-894-9407
Practice Address - Street 1:845 W EAST AVE
Practice Address - Street 2:NORTHERN VALLEY INDICAN HEALTH
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2002
Practice Address - Country:US
Practice Address - Phone:530-896-9400
Practice Address - Fax:530-894-9407
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK843363LF0000X
CA19459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKQ20585Medicare UPIN
AK160638Medicare ID - Type Unspecified