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NPI Code Detail

MEDICARE: EMMA O'CONNOR

MEDICARE: EMMA O'CONNOR
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
1367H00000XAnesthesiologist AssistantAL
2367H00000XAnesthesiologist Assistant75000230AIN

General Provider Information

NPI Number : 1962268573
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA O'CONNOR
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11141 PARKVIEW PLAZA DR STE 200
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1714
Country : US
Telephone Number : 260-425-6030
Fax Number : 260-425-6027
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2024
Last Update Date : 03/16/2026

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Directions to “ EMMA O'CONNOR ” Practice Location

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