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NPI Code Detail

MEDICARE: MICHAEL JEFFREY O'CONNELL CFNP

MEDICARE: MICHAEL JEFFREY O'CONNELL CFNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerR37541NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NM016345OTHERNMBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447253927
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JEFFREY O'CONNELL CFNP
Provider Business Mailing Address
First Line : PO BOX 691
Second Line :
City : MESILLA
State : NM
Zip : 88046-0691
Country : US
Telephone Number : 575-636-5019
Fax Number : 575-522-3415
Provider Business Practice Location Address
First Line : 2435 S TELSHOR BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-5029
Country : US
Telephone Number : 575-522-7798
Fax Number : 575-522-3415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 09/15/2023

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