MEDICARE: CHERYL O'CONNOR RN

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	163W00000X	Registered Nurse	RN232929L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528104676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL O'CONNOR RN

Provider Business Mailing Address
First Line	:	11 LORRAINE ST
Second Line	:
City	:	TAMAQUA
State	:	PA
Zip	:	18252-4453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1851 W END AVE
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-2050
Country	:	US
Telephone Number	:	570-628-2611
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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