Healthcare Provider Details

I. General information

NPI: 1497821177
Provider Name (Legal Business Name): SHERRILYN LYNETTE O'CONNOR RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4188 E STONE RIVER DR
TUCSON AZ
85712-6651
US

IV. Provider business mailing address

PO BOX 13430
TUCSON AZ
85732-3430
US

V. Phone/Fax

Practice location:
  • Phone: 520-888-2244
  • Fax: 520-318-1045
Mailing address:
  • Phone: 520-888-2244
  • Fax: 520-318-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN038904
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: