Provider Demographics
NPI:1275679615
Name:OCONNELL, NOREEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:NOREEN
Middle Name:
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W SQUANTUM ST
Mailing Address - Street 2:MANET COMMUNITY HEALTH CENTER INC
Mailing Address - City:NO QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2122
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:617-774-1906
Practice Address - Street 1:110 W SQUANTUM ST
Practice Address - Street 2:MANET COMMUNITY HEALTH CENTER INC
Practice Address - City:NO QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2122
Practice Address - Country:US
Practice Address - Phone:617-376-3000
Practice Address - Fax:617-774-1906
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22189Medicare UPIN
NP2991Medicare ID - Type Unspecified