Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71011131A | IN |
NPI | 1003480203 |
---|---|
Provider Name | James O'hara |
First Address | Evansville, IN 47725-9286 |
Second Address | Newburgh, IN 47630-9367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2021 |
Last Update Date | 13/05/2021 |