Provider Demographics
NPI:1942090204
Name:CONNOLLY, ADDYSON
Entity type:Individual
Prefix:
First Name:ADDYSON
Middle Name:
Last Name:CONNOLLY
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 1:22023 COPPER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-5709
Mailing Address - Country:US
Mailing Address - Phone:402-507-8522
Mailing Address - Fax:
Practice Address - Street 1:22023 COPPER RIDGE RD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-5709
Practice Address - Country:US
Practice Address - Phone:402-507-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide