Provider Demographics
NPI:1740207224
Name:OCONNOR, ELIZABETH A (FNP APRN MSN CCRN)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:FNP APRN MSN CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 15TH AVE S STE 202
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-952-1188
Mailing Address - Fax:406-952-1116
Practice Address - Street 1:401 15TH AVE S STE 202
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-952-1188
Practice Address - Fax:406-952-1116
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN13960363L00000X
MT13960363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00135814OtherRR MEDICARE
MT4303703Medicaid
MT4303703Medicaid