Individual provider · NPI-1

Liesl Marie Connelly, PA-C

Physician Assistant, Medical · Rockwall, TX

NPI number1235317702
StatusActive
Last updated in NPPESJul 29, 2008

Details

NPI
1235317702
Entity type
Individual (NPI-1)
Name
Liesl Marie Connelly
Credential
PA-C
Sex
Female
Sole proprietor
No
Enumeration date
Feb 6, 2008
Last updated
Jul 29, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363AM0700X Physician Assistant, MedicalPA05675TXYes

Practice location

1005 W. Ralph Hall Pkwy
Suite 201
Rockwall, TX 75032-6662

Phone 972-771-9081

Mailing address

1005 W. Ralph Hall Pkwy
Suite 201
Rockwall, TX 75032-6662

Phone 972-771-9081

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