Basic Information
| Provider Information | |||||||||
| NPI: | 1437396058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'CONNOR | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PMHCNS-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4977 BATTERY LANE | ||||||||
| Address2: | #914 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208144927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019514785 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6900 GEORGIA AVE.,NW | ||||||||
| Address2: | WALTER REED ARMY MEDICAL CENTER | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203075001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027823321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 01/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | RN26400 | DC | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 163WP0809X | RO72050 | MD | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.