Provider Demographics
NPI:1427704592
Name:SPEICHER, CONNIE LYNN (LSA)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:LYNN
Last Name:SPEICHER
Suffix:
Gender:F
Credentials:LSA
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Other - Credentials:
Mailing Address - Street 1:6300 WALNUT BEND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2388
Mailing Address - Country:US
Mailing Address - Phone:804-787-4891
Mailing Address - Fax:
Practice Address - Street 1:13710 ST FRANCIS BLVD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3267
Practice Address - Country:US
Practice Address - Phone:804-594-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0136000133208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery