Provider Demographics
NPI:1689495129
Name:O'CONNOR, ALEXANDRIA (MS, RDN, CSO)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MS, RDN, CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4215
Mailing Address - Country:US
Mailing Address - Phone:262-995-4200
Mailing Address - Fax:
Practice Address - Street 1:7302 43RD AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4215
Practice Address - Country:US
Practice Address - Phone:262-995-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5182-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered