MEDICARE: KATHLEEN MARY OCONNOR A.P.R.N.

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	207R00000X	Internal Medicine Physician	002732	CT
2	363LP2300X	Primary Care Nurse Practitioner	002732	CT
3	363LA2100X	Acute Care Nurse Practitioner	002732	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	400002732C703	OTHER	BCBS
2	020732	OTHER	CT CARE
3	2V6457	OTHER	HEALTHNET

General Provider Information

NPI Number	:	1457351017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARY OCONNOR A.P.R.N.

Provider Business Mailing Address
First Line	:	PO BOX 355
Second Line	:
City	:	GALES FERRY
State	:	CT
Zip	:	06335-0355
Country	:	US
Telephone Number	:	860-464-7253
Fax Number	:	860-464-7404

Provider Business Practice Location Address
First Line	:	1527 ROUTE 12
Second Line	:
City	:	GALES FERRY
State	:	CT
Zip	:	06335-1800
Country	:	US
Telephone Number	:	860-464-7253
Fax Number	:	860-464-7404

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	06/08/2023

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1527 ROUTE 12 , SUITE 1
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1669451894 — DR. SANFORD ALAN GREENHOUSE M.D.
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1548359078 — CHARLES R ESPOSITO M.D.
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1527 ROUTE 12
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06335-1800

Practice Phone: 860-464-7248
Practice Fax: 860-464-0125

1144319690 — MARK A. ROSENTHAL M.D.
Practice Location Address:

1527 ROUTE 12 , BOX 608
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1881783348 — PHYLLIS A. HOLTZMAN M.D.
Practice Location Address:

1527 ROUTE 12
GALES FERRY, CT
06335-1800

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1922197482 — STEVEN H. FORSTEIN M.D.
Practice Location Address:

1527 ROUTE 12
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06335-1800

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Directions to “ KATHLEEN MARY OCONNOR A.P.R.N.” Practice Location

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