Provider Demographics
NPI:1174132617
Name:CONNER, DENEA ROCHELLE
Entity type:Individual
Prefix:
First Name:DENEA
Middle Name:ROCHELLE
Last Name:CONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 AMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3902
Mailing Address - Country:US
Mailing Address - Phone:314-324-5404
Mailing Address - Fax:314-475-5027
Practice Address - Street 1:3445 AMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3902
Practice Address - Country:US
Practice Address - Phone:314-324-5404
Practice Address - Fax:314-475-5027
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1528484524Medicaid