Healthcare Provider Details

I. General information

NPI: 1306288659
Provider Name (Legal Business Name): CHRISTINE ALEXIS O'CONNOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TOZER ROAD LAHEY HEALTH PRIMARY CARE, BEVERLY
BEVERLY MA
01915-1166
US

IV. Provider business mailing address

38R ENON ST
BEVERLY MA
01915-1166
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-7727
  • Fax: 978-927-4598
Mailing address:
  • Phone: 978-927-7727
  • Fax: 978-927-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2277057
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: