Provider Demographics
NPI:1588095038
Name:BELFORD, CONNIE (CNP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:BELFORD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57442-1325
Mailing Address - Country:US
Mailing Address - Phone:605-765-2273
Mailing Address - Fax:605-765-2474
Practice Address - Street 1:606 E GARFIELD AVE STE C
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-1325
Practice Address - Country:US
Practice Address - Phone:605-765-2273
Practice Address - Fax:605-765-2474
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0057542363LF0000X
SDSD-CNP CP000830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily