Provider Demographics
NPI:1275071961
Name:O'CONNELL, KATHRYN
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W ELM ST
Mailing Address - Street 2:SUITE 2315
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1807
Mailing Address - Country:US
Mailing Address - Phone:415-710-4622
Mailing Address - Fax:
Practice Address - Street 1:300 W ELM ST
Practice Address - Street 2:SUITE 2315
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1807
Practice Address - Country:US
Practice Address - Phone:415-710-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017406363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology