| NPI | 1629735303 |
|---|---|
| Former Name | STEPHANIE ANDREA O'CONNOR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA R-12956) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2023-07-11 |