Basic Information
| Provider Information | |||||||||
| NPI: | 1558367375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNELL | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 DAVIDSON AVE | ||||||||
| Address2: | STE 204 | ||||||||
| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088734153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322711400 | ||||||||
| FaxNumber: | 7322713544 | ||||||||
| Practice Location | |||||||||
| Address1: | 3639 E VIEW DR | ||||||||
| Address2: | |||||||||
| City: | OREFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180692034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104281544 | ||||||||
| FaxNumber: | 6103959336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 04/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 027196 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | RN-200304-L | PA | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 11803004 | 01 | PA | CAQH | OTHER | 1402212 | 01 | PA | FIRST PRIORITY | OTHER | 0019682070001 | 05 | PA | MEDICAID | 1402212 | 01 | PA | HIGHMARK | OTHER | 2090513000 | 01 | PA | IBC | OTHER | 50014781 | 01 | PA | CAPITAL ADVANTAGE | OTHER | 77539 | 01 | PA | GEISINGER | OTHER | 0019682070003 | 05 | PA | MEDICAID | 7389432 | 01 | PA | AETNA | OTHER | 1545071 | 01 | PA | GATEWAY | OTHER |