Provider Demographics
NPI:1780157313
Name:CONNELL, JUDITH ANNE (ANP-C)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANNE
Last Name:CONNELL
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:CONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN-C
Mailing Address - Street 1:5 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-6129
Mailing Address - Country:US
Mailing Address - Phone:201-602-1211
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1937
Practice Address - Country:US
Practice Address - Phone:201-602-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00894000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily