Individual
TIFFANY O'CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
150 MUIR RD, MARTINEZ, CA 94553
(925) 372-2000
Mailing address
1713 HERMAN ST, RAPID CITY, SD 57701
(770) 238-2102
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P011922
SD
Other
Enumeration date
10/08/2015
Last updated
10/08/2015
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