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NPI Code Detail

MEDICARE: MRS. DANA MARIE O'CONNELL NP-C

MEDICARE: MRS. DANA MARIE O'CONNELL NP-C
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 PractitionerRN203523GA

General Provider Information

NPI Number : 1770972416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DANA MARIE O'CONNELL NP-C
Provider Business Mailing Address
First Line : 4589 LAWRENCEVILLE RD
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-7320
Country : US
Telephone Number : 770-446-8672
Fax Number :
Provider Business Practice Location Address
First Line : 4589 LAWRENCEVILLE RD
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-7320
Country : US
Telephone Number : 770-466-8672
Fax Number : 770-466-2082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2015
Last Update Date : 03/26/2025

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