Provider Demographics
NPI:1679892434
Name:O'CONNELL, CHRISTOPHER ROBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6001 MANUFACTURERS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-6207
Mailing Address - Country:US
Mailing Address - Phone:608-245-8441
Mailing Address - Fax:608-245-8498
Practice Address - Street 1:6001 MANUFACTURERS DR STE 110
Practice Address - Street 2:54TH CIVIL SUPPORT TEAM
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-6207
Practice Address - Country:US
Practice Address - Phone:608-245-8441
Practice Address - Fax:608-245-8498
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2525-023363A00000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider