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General NPI Number Information
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NPI Number | 1730550799
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Entity Type | Individual
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Provider Name | HEATHER O'CONNELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 13965 N. 75TH AVENUE
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City | PEORIA
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State | AZ
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Zip | 85381-6097
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Country | US
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Telephone | 602-843-2991
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Fax | 602-978-1226
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Provider Business Mailing Address
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Address Line | 13965 N. 75TH AVENUE
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City | PEORIA
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State | AZ
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Zip | 85381-6097
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Country | US
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Telephone | 602-843-2991
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Fax | 602-978-1226
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 6266
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License Number State | AZ
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