Provider Demographics
NPI:1861449191
Name:O'CONNOR, KAREN ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:TAVENNER
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3010 TOBACCO RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3618
Mailing Address - Country:US
Mailing Address - Phone:410-414-3335
Mailing Address - Fax:
Practice Address - Street 1:1300 PICCARD DR STE 202
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4697
Practice Address - Country:US
Practice Address - Phone:240-686-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR108183363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404181000Medicaid
MD404181000Medicaid
MDKR80I072Medicare ID - Type Unspecified