Provider Demographics
NPI:1811019391
Name:CONNOLLY, COLETTE BERNADETTE (APN)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:BERNADETTE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
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Mailing Address - Street 1:15242 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4165
Mailing Address - Country:US
Mailing Address - Phone:773-869-5648
Mailing Address - Fax:773-869-3632
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:773-869-5648
Practice Address - Fax:773-869-3632
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist