Provider Demographics
NPI:1629200704
Name:O'CONNELL, JAMIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-2523
Mailing Address - Country:US
Mailing Address - Phone:414-763-1445
Mailing Address - Fax:
Practice Address - Street 1:5735 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-2523
Practice Address - Country:US
Practice Address - Phone:414-763-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI162123-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse