Provider Demographics
NPI:1881280220
Name:CONNOR, MARTE ELLEN (RN)
Entity type:Individual
Prefix:
First Name:MARTE
Middle Name:ELLEN
Last Name:CONNOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3608
Mailing Address - Country:US
Mailing Address - Phone:641-919-2104
Mailing Address - Fax:
Practice Address - Street 1:803 S 2ND ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3608
Practice Address - Country:US
Practice Address - Phone:641-919-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113005163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA113005OtherRN