MEDICARE: MARY OCONNOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	220412	LA

General Provider Information

NPI Number	:	1386054864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY OCONNOR

Provider Business Mailing Address
First Line	:	193 GROVE PARK
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70068-6296
Country	:	US
Telephone Number	:	504-756-3517
Fax Number	:	985-359-1530

Provider Business Practice Location Address
First Line	:	193 GROVE PARK
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70068-6296
Country	:	US
Telephone Number	:	504-756-3517
Fax Number	:	985-359-1530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	05/05/2014

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Directions to “ MARY OCONNOR ” Practice Location

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