Provider Demographics
NPI:1669051553
Name:NEAL, CONNIE SUE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9497 TOWNSHIP ROAD 68 NW
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-9724
Mailing Address - Country:US
Mailing Address - Phone:740-919-9070
Mailing Address - Fax:
Practice Address - Street 1:9497 TOWNSHIP ROAD 68 NW
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:OH
Practice Address - Zip Code:43783-9724
Practice Address - Country:US
Practice Address - Phone:740-919-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider