Provider Demographics
NPI:1942536578
Name:CONNELLY, NANCY S (CD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 ROYAL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1955
Mailing Address - Country:US
Mailing Address - Phone:626-359-6310
Mailing Address - Fax:
Practice Address - Street 1:1910 ROYAL OAKS DR
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1955
Practice Address - Country:US
Practice Address - Phone:626-359-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC.D. (DONA)374J00000X
INC.D. (DONA)374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula