Provider Demographics
NPI:1154630259
Name:O'MEARA, KATHLEEN ERIN (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ERIN
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:WI
Mailing Address - Zip Code:54082-2124
Mailing Address - Country:US
Mailing Address - Phone:715-549-9123
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN085079367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered