Provider Demographics
NPI:1811029903
Name:CONNELL, ANITA JOHNSON (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:JOHNSON
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MD
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 50150
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015-0150
Mailing Address - Country:US
Mailing Address - Phone:425-228-5228
Mailing Address - Fax:425-228-5733
Practice Address - Street 1:1229 MADISON ST STE 1410
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3538
Practice Address - Country:US
Practice Address - Phone:206-329-3422
Practice Address - Fax:206-328-4636
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00019429207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1937705Medicaid
WA1937705Medicaid
WA000101031Medicare PIN