Provider Demographics
NPI:1780001586
Name:O'CONNOR, ELIZABETH LUCILLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LUCILLE
Last Name:O'CONNOR
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 1:202 PELLERIN RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-5167
Mailing Address - Country:US
Mailing Address - Phone:518-524-0825
Mailing Address - Fax:
Practice Address - Street 1:11 STEVENS ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1619
Practice Address - Country:US
Practice Address - Phone:518-431-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY541207-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse