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General NPI Number Information
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NPI Number | 1376889790
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Entity Type | Individual
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Provider Name | KATIE O'CONNOR RN
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Gender | Female
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 01/01/2018
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Provider Practice Location Address
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Address Line | 299 BREAD AND CHEESE HOLLOW RD
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City | NORTHPORT
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State | NY
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Zip | 11768-2615
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Country | US
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Telephone | 631-759-1687
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Fax |
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Provider Business Mailing Address
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Address Line | 299 BREAD AND CHEESE HOLLOW RD
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City | NORTHPORT
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State | NY
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Zip | 11768-2615
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Country | US
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Telephone | 631-759-1687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 313119
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 743275
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License Number State | NY
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