Provider Demographics
NPI:1053398610
Name:STRONG, CONNIE HALL (APRN)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:HALL
Last Name:STRONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:HARDY
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2240 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1511
Mailing Address - Country:US
Mailing Address - Phone:801-393-5355
Mailing Address - Fax:801-394-4609
Practice Address - Street 1:22 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1043
Practice Address - Country:US
Practice Address - Phone:801-525-4900
Practice Address - Fax:801-394-3693
Is Sole Proprietor?:No
Enumeration Date:2005-12-26
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2137244405364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT262079OtherU002
UT942938348ST5OtherU003
UT942938348OtherU009
UT004662127OtherRCAR
UT104472OtherU005
UT107001407101OtherU006
UT004662127OtherICAR
UT104472OtherU005
UT004662127OtherICAR