Healthcare Provider Details

I. General information

NPI: 1164459285
Provider Name (Legal Business Name): NANCY J O'CONNOR N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN STREET THE CARDIOVASCULAR SPECIALISTS, LLC
HYANNIS MA
02601
US

IV. Provider business mailing address

25 MAIN ST
HYANNIS MA
02601-3129
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-1829
  • Fax: 508-778-0113
Mailing address:
  • Phone: 508-778-1829
  • Fax: 508-778-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number164548
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: