Provider Demographics
NPI:1821666207
Name:IRVIN-CONNELLY, LINDSIE JORDAN
Entity Type:Individual
Prefix:
First Name:LINDSIE
Middle Name:JORDAN
Last Name:IRVIN-CONNELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7617
Mailing Address - Country:US
Mailing Address - Phone:303-656-0085
Mailing Address - Fax:
Practice Address - Street 1:1627 N 14TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7617
Practice Address - Country:US
Practice Address - Phone:303-656-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA.787438374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide