Provider Demographics
NPI:1114319746
Name:SYROPOULOS, CONNIE MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:SYROPOULOS
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30625 MARTINDALE RD APT 106
Mailing Address - Street 2:
Mailing Address - City:NEW HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:48165-9839
Mailing Address - Country:US
Mailing Address - Phone:313-204-7544
Mailing Address - Fax:629-837-5940
Practice Address - Street 1:922 W BAXTER DR STE 1110
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8613
Practice Address - Country:US
Practice Address - Phone:385-281-9846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT217324363LG0600X
UT12218275-4405363LG0600X
OH021522363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health