Provider Demographics
NPI:1336623180
Name:O'CONNOR, KAMIE LYNN
Entity Type:Individual
Prefix:
First Name:KAMIE
Middle Name:LYNN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 COUNTY ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:NORTH BANGOR
Mailing Address - State:NY
Mailing Address - Zip Code:12966-3612
Mailing Address - Country:US
Mailing Address - Phone:518-317-7032
Mailing Address - Fax:
Practice Address - Street 1:31 6TH ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1246
Practice Address - Country:US
Practice Address - Phone:518-481-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY756087163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse