Provider Demographics
NPI:1154096212
Name:O'CONNOR, JACQUELYN (CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST STE 466
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1629
Mailing Address - Country:US
Mailing Address - Phone:617-969-8989
Mailing Address - Fax:
Practice Address - Street 1:2000 WASHINGTON ST STE 466
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1629
Practice Address - Country:US
Practice Address - Phone:617-969-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2302755363LP0200X
MA202120722363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics