Provider Demographics
NPI:1902900210
Name:O'NEILL, KATHLEEN H (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:H
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:23 GLOUCESTER LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1615
Mailing Address - Country:US
Mailing Address - Phone:860-206-2298
Mailing Address - Fax:860-667-6799
Practice Address - Street 1:555 WILLARD AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2631
Practice Address - Country:US
Practice Address - Phone:860-666-6951
Practice Address - Fax:860-667-6799
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000369363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology