Doctor Name: | THERESA CONROY |
NPI Number: | 1255584587 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 003909 |
Business Practice Address: | 36 Pershing Dr Ansonia, CT - 064012214 |
Business Phone Number: | 6122251534 |
Business Fax Number: | |
Mailing Address: | 36 Pershing Dr, ANSONIA |
State: | CT |
Postal Code: | 064012214 |
Phone Number: | 6122251534 |
Fax Number: | |
NPI Enumeration Date: | 10/30/2008 |
NPI Last Update Date: | 06/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 003909 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |