Healthcare Provider Details

I. General information

NPI: 1679881676
Provider Name (Legal Business Name): RACHEL M O'CONNOR N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL M AXSOM R.N.

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 S ROGERS ST
BLOOMINGTON IN
47403-4752
US

IV. Provider business mailing address

PO BOX 1149
BLOOMINGTON IN
47402-1149
US

V. Phone/Fax

Practice location:
  • Phone: 812-676-4144
  • Fax: 812-339-8344
Mailing address:
  • Phone: 812-353-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003406A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: