Provider Demographics
NPI:1033675087
Name:O'MEARA, MARY B (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:B
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5287
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61125-0287
Mailing Address - Country:US
Mailing Address - Phone:815-484-6300
Mailing Address - Fax:815-395-2021
Practice Address - Street 1:1235 N MULFORD RD STE 210
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3879
Practice Address - Country:US
Practice Address - Phone:815-484-6300
Practice Address - Fax:815-395-2021
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018733363LF0000X
IL277.002260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily