Provider Demographics
NPI:1992394019
Name:O'CONNOR, MICHELLE ANNA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNA
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANNA
Other - Last Name:KUHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:17 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2250
Mailing Address - Country:US
Mailing Address - Phone:781-572-2739
Mailing Address - Fax:
Practice Address - Street 1:17 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2250
Practice Address - Country:US
Practice Address - Phone:781-572-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2335626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily