Provider Demographics
NPI:1841422409
Name:O'CONNOR, NATALIE J (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:J
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SCOTT ROLEN DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2700
Mailing Address - Country:US
Mailing Address - Phone:812-482-5656
Mailing Address - Fax:812-482-5962
Practice Address - Street 1:440 SCOTT ROLEN DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2700
Practice Address - Country:US
Practice Address - Phone:812-482-5656
Practice Address - Fax:812-482-5962
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168497A163W00000X
IN71003034A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200966170Medicaid
254830FMedicare PIN