Healthcare Provider Details

I. General information

NPI: 1275352304
Provider Name (Legal Business Name): COURTNEY O'CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY NEWLIN

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 N CALIFORNIA BLVD
WALNUT CREEK CA
94596-4126
US

IV. Provider business mailing address

513 NORRIS CANYON TER
SAN RAMON CA
94583-1493
US

V. Phone/Fax

Practice location:
  • Phone: 925-708-7170
  • Fax:
Mailing address:
  • Phone: 925-708-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: