=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578456299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN D O'CONNELL RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2025
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 N 175TH ST
-----------------------------------------------------
City | SHORELINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-5064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-401-3175
-----------------------------------------------------
Fax | 206-401-3201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5127
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98206-5127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-860-5414
-----------------------------------------------------
Fax | 206-720-8462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP70035316
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN61326168
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------