Provider Demographics
NPI:1396224358
Name:O'CONNOR, ELIZABETH PATRICK
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PATRICK
Last Name:O'CONNOR
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 1:52 PINCKNEY ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3424
Mailing Address - Country:US
Mailing Address - Phone:508-335-2361
Mailing Address - Fax:
Practice Address - Street 1:165 CAMBRIDGE ST STE 820
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2747
Practice Address - Country:US
Practice Address - Phone:617-643-2062
Practice Address - Fax:617-726-2958
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2307256163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse