Healthcare Provider Details

I. General information

NPI: 1942769484
Provider Name (Legal Business Name): NICOLE RACHEL O'CONNOR DNP, APRN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE RACHEL ROBINETTE RN

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

9233 W 100TH AVE
SAINT JOHN IN
46373-8014
US

V. Phone/Fax

Practice location:
  • Phone: 708-289-5019
  • Fax:
Mailing address:
  • Phone: 708-289-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71013468A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277002111
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number2018028919
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2009022174
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: