Provider Demographics
NPI:1609609098
Name:OCONNOR, MARIANN (LVN)
Entity type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-0430
Mailing Address - Country:US
Mailing Address - Phone:805-792-4581
Mailing Address - Fax:
Practice Address - Street 1:4812 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-0430
Practice Address - Country:US
Practice Address - Phone:805-792-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208114164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse