Provider Demographics
NPI:1407026206
Name:O'MALLEY, CAROLYN ANN (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 STEGMAN PKWY
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1409
Mailing Address - Country:US
Mailing Address - Phone:201-434-7465
Mailing Address - Fax:
Practice Address - Street 1:390 STEGMAN PKWY
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1409
Practice Address - Country:US
Practice Address - Phone:201-434-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10879400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse