Provider Demographics
NPI:1467435230
Name:O'CONNELL, PATRICIA (CGN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:CGN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 N HAGGERTY RD
Mailing Address - Street 2:BLDG. #3
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3820
Mailing Address - Country:US
Mailing Address - Phone:734-844-8828
Mailing Address - Fax:
Practice Address - Street 1:860 N HAGGERTY RD
Practice Address - Street 2:BLDG. #3
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3820
Practice Address - Country:US
Practice Address - Phone:734-844-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27 11335164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse