Provider Demographics
NPI:1942769484
Name:O'CONNOR, NICOLE RACHEL (DNP, APRN, CPNP-AC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RACHEL
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-AC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RACHEL
Other - Last Name:ROBINETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9233 W 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8014
Mailing Address - Country:US
Mailing Address - Phone:708-289-5019
Mailing Address - Fax:
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-289-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009022174163W00000X
IN71013468A363L00000X
MO2018028919363LP0222X
IL277002111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018028919OtherNATIONAL COUNCIL OF STATE BOARDS OF NURSING
20186482OtherPEDIATRIC NURSING CERTIFICATION BOARD