Doctor Name: | DR. EVE ALISON CONNOLLY |
NPI Number: | 1598081630 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | MD067243L |
Business Practice Address: | 90 Hope Dr Mountain Home A F B, ID - 836481057 |
Business Phone Number: | 2088287900 |
Business Fax Number: | |
Mailing Address: | 361 Gunfighter Cir, MOUNTAIN HOME A F B |
State: | ID |
Postal Code: | 836481199 |
Phone Number: | 2019137123 |
Fax Number: | |
NPI Enumeration Date: | 04/14/2010 |
NPI Last Update Date: | 04/14/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | MD067243L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |