Healthcare Provider Details

I. General information

NPI: 1912499252
Provider Name (Legal Business Name): CHRISTIN O'CONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIN WEIR

II. Dates (important events)

Enumeration Date: 06/02/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 EXECUTIVE CENTRE PKWY SUITE 100
ST.PETERS MO
63376
US

IV. Provider business mailing address

7748 ARDMORE DR
O'FALLON MO
63368
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-1901
  • Fax:
Mailing address:
  • Phone: 314-775-7918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8434-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: