Provider Demographics
NPI:1831970706
Name:O'CONNOR, RENA ARLENE (PA-C)
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:ARLENE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 SOUTH BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1494
Mailing Address - Country:US
Mailing Address - Phone:716-481-7960
Mailing Address - Fax:
Practice Address - Street 1:13640 STEELECROFT PKWY STE 320
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7880
Practice Address - Country:US
Practice Address - Phone:704-302-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001013466363A00000X, 363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant