Provider Demographics
NPI:1023291911
Name:CONNELLY, DESIREE ROSE (CNM)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:ROSE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:ROSE
Other - Last Name:ADAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:12302 SE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:312-752-8159
Mailing Address - Fax:
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:SUITE 950
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-988-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60260849176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife