Provider Demographics
NPI:1386815546
Name:O'KANE-SMALLEY, MAUREEN ANN (NP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:O'KANE-SMALLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 VARNUM AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-452-9700
Mailing Address - Fax:978-441-6075
Practice Address - Street 1:275 VARNUM AVE
Practice Address - Street 2:STE 201
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-452-9700
Practice Address - Fax:978-441-6075
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA193622OtherLICENSE
MA193622OtherLICENSE
MA000506703Medicare PIN