Provider Demographics
NPI:1164601423
Name:OSULLIVAN, JAMES NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NOEL
Last Name:OSULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15664 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2234
Mailing Address - Country:US
Mailing Address - Phone:402-210-6150
Mailing Address - Fax:402-341-1851
Practice Address - Street 1:4102 WOOLWORTH AVE
Practice Address - Street 2:DOUGLAS COUNTY COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1899
Practice Address - Country:US
Practice Address - Phone:402-444-7449
Practice Address - Fax:402-341-1851
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE129242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry