Healthcare Provider Details

I. General information

NPI: 1073547568
Provider Name (Legal Business Name): PATRICIA ANN O'NEILL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MILL HILL AVE 3RD FLOOR
BRIDGEPORT CT
06610-2826
US

IV. Provider business mailing address

PO BOX 415126
BOSTON MA
02241-5126
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3394
  • Fax: 203-384-3829
Mailing address:
  • Phone: 203-384-3975
  • Fax: 203-384-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number000873
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: