Provider Demographics
NPI:1528009784
Name:O'CONNOR, SUSANN CONNER (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSANN
Middle Name:CONNER
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:RAMONA
Other - Middle Name:SUSANN
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:6701 AIRPORT BLVD STE A101
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6767
Mailing Address - Country:US
Mailing Address - Phone:251-633-8880
Mailing Address - Fax:251-378-6222
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE A-101
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-633-8880
Practice Address - Fax:251-634-4507
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1077257363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP88926Medicare UPIN