Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2017032723 | MO |
NPI | 1033627997 |
---|---|
Provider Name | Erin Omalley |
First Address | Cape Girardeau, MO 63701-3423 |
Second Address | Gainesville, FL 32608-1135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2018 |
Last Update Date | 19/07/2021 |