Individual
MARY THERESA O'CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2201 HEMPSTEAD TPKE, EAST MEADOW, NY 11554-1859
(516) 572-0213
(703) 766-9725
Mailing address
3998 FAIR RIDGE DR., SUITE 300, FAIRFAX, VA 22033-2921
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
325700
NY
367500000X
Certified Registered Nurse Anesthetist
RN325700
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070805000003
FIDELIS
NY
Enumeration date
06/30/2006
Last updated
01/15/2015
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