Provider Demographics
NPI:1790391951
Name:O'CONNOR, ANN MARIE
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
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 1:620 GLEN ST APT 302
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3236
Mailing Address - Country:US
Mailing Address - Phone:206-406-6065
Mailing Address - Fax:
Practice Address - Street 1:543 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3162
Practice Address - Country:US
Practice Address - Phone:206-759-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2024-10-15
Deactivation Date:2021-07-12
Deactivation Code:
Reactivation Date:2024-05-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist