Basic Information
| Provider Information | |||||||||
| NPI: | 1902925266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONNOLLY | ||||||||
| FirstName: | KARIN | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ADULT NURSE PRACTITI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6439 GARNERS FERRY RD. | ||||||||
| Address2: | (WM, JENNINGS BRYAN DORN VAMC) | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037764000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4100 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454289000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138913100 | ||||||||
| FaxNumber: | 5134876052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 11/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 143132 | OH | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LA2200X | ARNP9283958 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.