Provider Demographics
NPI:1770048894
Name:O'CONNELL, TERESA (ACNP-BC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10516 SAWMILL RD # 41
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7299
Mailing Address - Country:US
Mailing Address - Phone:614-557-7394
Mailing Address - Fax:
Practice Address - Street 1:10516 SAWMILL RD # 41
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7299
Practice Address - Country:US
Practice Address - Phone:614-401-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.13182207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty