| Doctor Name: | JOAN LESLIE NYCKLEMOE-CONNELL |
| NPI Number: | 1477570943 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PAC0141 |
| Business Practice Address: | 332 2nd Ave N Wahpeton, ND - 580754528 |
| Business Phone Number: | 7016427000 |
| Business Fax Number: | 7016427055 |
| Mailing Address: | 332 2nd Ave N, WAHPETON |
| State: | ND |
| Postal Code: | 580754528 |
| Phone Number: | 7016427000 |
| Fax Number: | 7016427055 |
| NPI Enumeration Date: | 07/17/2006 |
| NPI Last Update Date: | 09/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PAC0141 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |