Provider Demographics
NPI:1699151027
Name:HELMUTH, CONNIE SUE (FNP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:HELMUTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 TENNESSEE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-4735
Mailing Address - Country:US
Mailing Address - Phone:937-532-4127
Mailing Address - Fax:
Practice Address - Street 1:1400 BRUSH ROW RD
Practice Address - Street 2:
Practice Address - City:WILBERFORCE
Practice Address - State:OH
Practice Address - Zip Code:45384-5800
Practice Address - Country:US
Practice Address - Phone:937-376-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17411-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily