1104849652 NPI number — MS. ELIZABETH P. O'CONNOR CRNA

Table of content: (NPI 1548385438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104849652 NPI number — MS. ELIZABETH P. O'CONNOR CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNOR
Provider First Name:
ELIZABETH
Provider Middle Name:
P.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104849652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11781 LEE JACKSON MEMORIAL HWY
Provider Second Line Business Mailing Address:
SUITE 550
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033-3309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-777-5102
Provider Business Mailing Address Fax Number:
703-563-6256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 GLENN MITCHELL DRIVE, SUITE 102
Provider Second Line Business Practice Location Address:
GASTROENTEROLOGY CONSULTANTS
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-464-1644
Provider Business Practice Location Address Fax Number:
703-563-6256
Provider Enumeration Date:
07/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  NA2725 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 0024147143 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)