Provider Demographics
NPI:1457658973
Name:O'LEARY, COLLEEN MARY (RN, AOCNS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARY
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:RN, AOCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2625
Mailing Address - Country:US
Mailing Address - Phone:773-965-4727
Mailing Address - Fax:
Practice Address - Street 1:25 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2625
Practice Address - Country:US
Practice Address - Phone:773-965-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041317602163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology