Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 05974 | OH |
NPI | 1003888330 |
---|---|
Provider Name | Nadine Omalley |
First Address | Youngstown, OH 44507 |
Second Address | Cortland, OH 44410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007754 | (05) | OH |
0246111 | (05) | OH |
P34711 | (02) |