Provider Demographics
NPI:1952942864
Name:O'CONNOR, NATALIE (LPN, CLC)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LPN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 PARSELLS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-5422
Mailing Address - Country:US
Mailing Address - Phone:315-573-0213
Mailing Address - Fax:
Practice Address - Street 1:756 PARSELLS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-5422
Practice Address - Country:US
Practice Address - Phone:315-573-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304369-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse