Provider Demographics
NPI:1356436968
Name:CONNELLY, ELIZABETH M (ARNP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PNS CREDENTIALING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:394 SINGLETON RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9150
Practice Address - Country:US
Practice Address - Phone:843-347-8050
Practice Address - Fax:843-347-8049
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22362363LA2200X
NY306485-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP7449Medicaid
VT1008944Medicaid
NHNP3804Medicare ID - Type UnspecifiedNH MEDICARE NUMBER
NHP60275Medicare UPIN