Provider Demographics
NPI:1245569813
Name:SPIRA O'CONNOR, ANDREA LYNN (NMD, RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:SPIRA O'CONNOR
Suffix:
Gender:F
Credentials:NMD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 N 16TH ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1752
Mailing Address - Country:US
Mailing Address - Phone:480-252-3799
Mailing Address - Fax:
Practice Address - Street 1:6102 N 16TH ST
Practice Address - Street 2:SUITE 17
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1752
Practice Address - Country:US
Practice Address - Phone:480-252-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1168175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath