Healthcare Provider Details

I. General information

NPI: 1093378663
Provider Name (Legal Business Name): JANE BROOKS O'CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 KIRMAN AVE
RENO NV
89502-0993
US

IV. Provider business mailing address

3781 ZOROASTER CT
SPARKS NV
89436-5444
US

V. Phone/Fax

Practice location:
  • Phone: 775-326-2920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076009
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: