Provider Demographics
NPI:1730182155
Name:MCCONNELL, JEANNE T (APRN)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:T
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 1E20
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-8003
Mailing Address - Country:US
Mailing Address - Phone:302-733-5700
Mailing Address - Fax:
Practice Address - Street 1:4765 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 1E20
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-8003
Practice Address - Country:US
Practice Address - Phone:302-733-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELN-0000127363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001183942Medicaid
G02627C06Medicare PIN
DE0001183942Medicaid