Basic Information
Provider Information | |||||||||
NPI: | 1437418621 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | O'CONNOR | ||||||||
FirstName: | LAURA | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1250 S CLEARVIEW AVE STE 100 | ||||||||
Address2: | URGENT CARE EXTRA | ||||||||
City: | MESA | ||||||||
State: | AZ | ||||||||
PostalCode: | 852093378 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4809889108 | ||||||||
FaxNumber: | 4808134460 | ||||||||
Practice Location | |||||||||
Address1: | 641 W WARNER RD | ||||||||
Address2: |   | ||||||||
City: | GILBERT | ||||||||
State: | AZ | ||||||||
PostalCode: | 852337266 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4807229828 | ||||||||
FaxNumber: | 4807229831 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/09/2012 | ||||||||
LastUpdateDate: | 08/24/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RN089020 | AZ | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 363L00000X | AP4424 | AZ | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | 4424 | 01 | AZ | LICENSE | OTHER |