Provider Demographics
NPI:1942446893
Name:CONNOLLY-DETURA, PATRICIA MARY (RN, CNM)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARY
Last Name:CONNOLLY-DETURA
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3024
Mailing Address - Country:US
Mailing Address - Phone:201-384-4955
Mailing Address - Fax:201-384-2559
Practice Address - Street 1:114 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3024
Practice Address - Country:US
Practice Address - Phone:201-384-4955
Practice Address - Fax:201-384-2559
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR05601200163W00000X
NY344654-1163W00000X
175L00000X
NJ25ME00016101176B00000X
NYF000634-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No175L00000XOther Service ProvidersHomeopath