Provider Demographics
NPI:1124312350
Name:O'CONNOR, THAO THACH (C-FNP)
Entity type:Individual
Prefix:
First Name:THAO
Middle Name:THACH
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-726-8722
Mailing Address - Fax:617-726-6781
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 340
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-726-8722
Practice Address - Fax:617-726-6781
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN252917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily