Provider Demographics
NPI:1003951310
Name:OHARA, LAURA J (RN, PNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:OHARA
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 SAMARITAN DRIVE
Mailing Address - Street 2:SUITE 815
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4109
Mailing Address - Country:US
Mailing Address - Phone:408-358-3573
Mailing Address - Fax:
Practice Address - Street 1:2577 SAMARITAN DRIVE
Practice Address - Street 2:SUITE 815
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4109
Practice Address - Country:US
Practice Address - Phone:408-358-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 6383363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics