Provider Demographics
NPI:1568496867
Name:O'CONNOR, SHARON ELLIOTT
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELLIOTT
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 1:305 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 337
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-8327
Mailing Address - Country:US
Mailing Address - Phone:612-273-5400
Mailing Address - Fax:
Practice Address - Street 1:305 E NICOLLET BLVD
Practice Address - Street 2:SUITE 377
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-8327
Practice Address - Country:US
Practice Address - Phone:612-273-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN14Q28OCOtherBLUE CROSS BLUE SHIELD
6401757OtherMEDICA