Provider Demographics
NPI:1982015053
Name:CONNOLLY, MAUREEN ELIZABETH (MSN RNC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MSN RNC
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:CONNOLLY
Other - Last Name:PFENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 UNION STATION PLAZA
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015
Mailing Address - Country:US
Mailing Address - Phone:484-526-2786
Mailing Address - Fax:484-893-7096
Practice Address - Street 1:240 UNION STATION PLAZA
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015
Practice Address - Country:US
Practice Address - Phone:484-526-2786
Practice Address - Fax:484-893-7096
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN341432L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029269390001Medicaid