Healthcare Provider Details

I. General information

NPI: 1295374379
Provider Name (Legal Business Name): CAITLIN E O'CONNOR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH ST
GREELEY CO
80631-5154
US

IV. Provider business mailing address

2066 MAHAFFIE COURT
MONUMENT CO
80132
US

V. Phone/Fax

Practice location:
  • Phone: 970-420-0905
  • Fax:
Mailing address:
  • Phone: 719-502-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0995272
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: