Healthcare Provider Details

I. General information

NPI: 1164812947
Provider Name (Legal Business Name): CAROLYN JOYCE OCONNOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOYCE OCONNOR

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BECK AVE
FAIRFIELD CA
94533-6804
US

IV. Provider business mailing address

7044 SARONI DR
OAKLAND CA
94611-1452
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-8400
  • Fax:
Mailing address:
  • Phone: 510-339-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number661390
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number661390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: