Provider Demographics
NPI:1225896624
Name:O'MEARA, RYLIE
Entity Type:Individual
Prefix:
First Name:RYLIE
Middle Name:
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 N MAPLEWOOD AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1878
Mailing Address - Country:US
Mailing Address - Phone:402-570-6287
Mailing Address - Fax:
Practice Address - Street 1:1432 N MAPLEWOOD AVE APT 304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1878
Practice Address - Country:US
Practice Address - Phone:402-570-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program