Provider Demographics
NPI:1255303756
Name:O'CONNOR, MARY F (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-9506
Mailing Address - Country:US
Mailing Address - Phone:641-648-7000
Mailing Address - Fax:641-648-7093
Practice Address - Street 1:112 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ZEARING
Practice Address - State:IA
Practice Address - Zip Code:50278-7728
Practice Address - Country:US
Practice Address - Phone:641-487-7800
Practice Address - Fax:641-487-7803
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA097778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48619Medicare ID - Type Unspecified
IA15304Medicare ID - Type Unspecified
S56152Medicare UPIN
IA15401Medicare ID - Type Unspecified
IA0634600Medicaid
IA48620OtherWELLMARK BCBS
IA1117994Medicaid
S56152Medicare UPIN
IA15401Medicare ID - Type Unspecified
IA48619OtherWELLMARK BCBS