Provider Demographics
NPI:1992753065
Name:CONNELL, STACEY ANN (APRN,BC)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:CONNELL
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1442
Practice Address - Street 1:218A DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071
Practice Address - Country:US
Practice Address - Phone:610-826-6353
Practice Address - Fax:610-826-6359
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner