Provider Demographics
NPI:1114201365
Name:O'LEARY, JULIA ELAINE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ELAINE
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10680 CEDAR BEND CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8204
Mailing Address - Country:US
Mailing Address - Phone:775-200-8528
Mailing Address - Fax:775-800-1551
Practice Address - Street 1:85 KEYSTONE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5571
Practice Address - Country:US
Practice Address - Phone:775-200-8528
Practice Address - Fax:775-800-1551
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1114201365Medicaid