MEDICARE: LISA O'CONNER

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
1	363LF0000X	Family Nurse Practitioner	5023797	NC

General Provider Information

NPI Number	:	1972453538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA O'CONNER

Provider Business Mailing Address
First Line	:	8908 NIGHTINGALE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4612
Country	:	US
Telephone Number	:	843-637-0113
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 S SHARON AMITY RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2886
Country	:	US
Telephone Number	:	704-446-2360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ LISA O'CONNER ” Practice Location

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