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General NPI Number Information
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NPI Number | 1437418621
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Entity Type | Individual
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Provider Name | LAURA S O'CONNOR FNP
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Gender | Female
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 641 W WARNER RD
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City | GILBERT
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State | AZ
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Zip | 85233-7266
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Country | US
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Telephone | 480-722-9828
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Fax | 480-722-9831
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Provider Business Mailing Address
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Address Line | 1250 S CLEARVIEW AVE STE 100 URGENT CARE EXTRA
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City | MESA
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State | AZ
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Zip | 85209-3378
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Country | US
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Telephone | 480-988-9108
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Fax | 480-813-4460
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | RN089020
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP4424
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License Number State | AZ
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