Healthcare Provider Details

I. General information

NPI: 1295331130
Provider Name (Legal Business Name): MS. NANCY O'CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 05/04/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 S VALLEY VIEW BLVD STE 1
LAS VEGAS NV
89102-0145
US

IV. Provider business mailing address

10320 WALWORTH AVE
LAS VEGAS NV
89166-6500
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax:
Mailing address:
  • Phone: 702-490-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9034-S
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: