Provider Demographics
NPI:1720782543
Name:CONNER, ADRIENNE SHAVONNE
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:SHAVONNE
Last Name:CONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHELSEA CORS # 3080
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-7401
Mailing Address - Country:US
Mailing Address - Phone:205-514-5066
Mailing Address - Fax:866-984-4212
Practice Address - Street 1:130 FUNDERBURG LN
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-8617
Practice Address - Country:US
Practice Address - Phone:205-514-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide