Healthcare Provider Details

I. General information

NPI: 1750495610
Provider Name (Legal Business Name): LESLIE HETZEL O'CONNOR APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YALE- NEW HAVEN HOSPITAL 20 YORK STREET
NEW HAVEN CT
06504
US

IV. Provider business mailing address

49 DEAN DR
SOUTH GLASTONBURY CT
06073-3301
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-9216
  • Fax: 203-688-9709
Mailing address:
  • Phone: 860-659-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number001566
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number001566
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: