Healthcare Provider Details

I. General information

NPI: 1275742892
Provider Name (Legal Business Name): JANE ANN O'CONNOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 VALLEY RD
NORTHBROOK IL
60062-6342
US

IV. Provider business mailing address

1321 W NORWOOD ST
CHICAGO IL
60660-2509
US

V. Phone/Fax

Practice location:
  • Phone: 847-509-8302
  • Fax:
Mailing address:
  • Phone: 773-508-1766
  • Fax: 773-508-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: