Provider Demographics
NPI:1710235213
Name:O'CONNOR, PEGGY L (FNP)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:O'CONNOR
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0589
Mailing Address - Country:US
Mailing Address - Phone:907-822-3203
Mailing Address - Fax:907-822-5805
Practice Address - Street 1:MILE 187 GLENN HIGHWAY
Practice Address - Street 2:
Practice Address - City:GLENNALLEN
Practice Address - State:AK
Practice Address - Zip Code:99588
Practice Address - Country:US
Practice Address - Phone:907-822-3203
Practice Address - Fax:907-822-5805
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000735363LF0000X
AKNURU1369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1599641Medicaid