Provider Demographics
NPI:1770085961
Name:CONNOLLY, SARAH JEAN (LPN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VALDEPENAS LN
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5810
Mailing Address - Country:US
Mailing Address - Phone:518-371-3717
Mailing Address - Fax:
Practice Address - Street 1:12 VALDEPENAS LN
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-5810
Practice Address - Country:US
Practice Address - Phone:518-371-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326403-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse