Provider Demographics
NPI:1356860506
Name:OCONNOR, LAURA ROSE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ROSE
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LANSING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-2400
Mailing Address - Country:US
Mailing Address - Phone:517-543-5110
Mailing Address - Fax:
Practice Address - Street 1:111 LANSING ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-2400
Practice Address - Country:US
Practice Address - Phone:517-543-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704220985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily