Provider Demographics
NPI:1912680638
Name:CONNELL, WILLIAM
Entity Type:Individual
Prefix:PROF
First Name:WILLIAM
Middle Name:
Last Name:CONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6278 WILFORD CT SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3761
Mailing Address - Country:US
Mailing Address - Phone:541-981-7500
Mailing Address - Fax:
Practice Address - Street 1:2668 OAK RIDGE ST NW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1070
Practice Address - Country:US
Practice Address - Phone:541-405-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider