Provider Demographics
NPI:1154507135
Name:OHARA, CARLENE LAVERNE (LPN)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:LAVERNE
Last Name:OHARA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CARLENE
Other - Middle Name:LAVERNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:23814 STATE HIGHWAY T
Mailing Address - Street 2:
Mailing Address - City:EXCELLO
Mailing Address - State:MO
Mailing Address - Zip Code:65247-2002
Mailing Address - Country:US
Mailing Address - Phone:573-489-0732
Mailing Address - Fax:
Practice Address - Street 1:23814 STATE HIGHWAY T
Practice Address - Street 2:
Practice Address - City:EXCELLO
Practice Address - State:MO
Practice Address - Zip Code:65247-2002
Practice Address - Country:US
Practice Address - Phone:573-489-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043529164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse