Individual
BRENDA LYNN O'CONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
74 WHITMAN AVE, ISLIP, NY 11751-1413
(631) 650-9264
Mailing address
74 WHITMAN AVE, ISLIP, NY 11751-1413
(631) 650-9264
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
308201
NY
Other
Enumeration date
11/09/2011
Last updated
11/09/2011
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