Provider Demographics
NPI:1770851610
Name:O'CONNOR, LEO SHANNON (NP)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:SHANNON
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:12302 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5807
Mailing Address - Country:US
Mailing Address - Phone:317-564-4836
Mailing Address - Fax:317-587-2341
Practice Address - Street 1:11455 N MERIDIAN ST
Practice Address - Street 2:200
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1624
Practice Address - Country:US
Practice Address - Phone:317-582-8180
Practice Address - Fax:317-582-8182
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2012-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28129315A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health