Basic Information
| Provider Information | |||||||||
| NPI: | 1396339933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRINDIVILLE | ||||||||
| FirstName: | CONOR | ||||||||
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| Credential: | CNIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 S ULSTER ST STE 1225 | ||||||||
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| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802372696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202873093 | ||||||||
| FaxNumber: | 7202873195 | ||||||||
| Practice Location | |||||||||
| Address1: | 3929 E BELL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029235000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2021 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.