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General NPI Number Information
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NPI Number | 1679234926
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Entity Type | Individual
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Provider Name | CORY ANN O'CONNELL AGCNS-BC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 13520 PIPING PLOVER DR
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City | AUSTIN
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State | TX
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Zip | 78729-8097
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Country | US
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Telephone | 774-991-1996
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Fax |
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Provider Business Mailing Address
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Address Line | 13520 PIPING PLOVER DR
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City | AUSTIN
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State | TX
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Zip | 78729-8097
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Country | US
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Telephone | 774-991-1996
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 1018938
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License Number State | TX
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