Provider Demographics
NPI:1003888330
Name:OMALLEY, NADINE (CRNP)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:OMALLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E MIDLOTHIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507
Mailing Address - Country:US
Mailing Address - Phone:330-788-6506
Mailing Address - Fax:330-788-7805
Practice Address - Street 1:2668 ELM RD
Practice Address - Street 2:STE 1, BLDG C
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410
Practice Address - Country:US
Practice Address - Phone:330-399-5104
Practice Address - Fax:330-395-2231
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH276038163WW0101X
OH05974363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007754Medicaid
OH0246111Medicaid
P34711Medicare UPIN
OHNP08282Medicare ID - Type Unspecified
OH0246111Medicaid