Provider Demographics
NPI:1558135855
Name:OCONNELL, ILEANE PATRICIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ILEANE
Middle Name:PATRICIA
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:ILEANE
Other - Middle Name:PATRICIA
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-3040
Mailing Address - Country:US
Mailing Address - Phone:518-912-9592
Mailing Address - Fax:
Practice Address - Street 1:159 WOLF RD STE 105
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-6008
Practice Address - Country:US
Practice Address - Phone:518-437-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296125-01164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse