Provider Demographics
NPI:1508926395
Name:O'LEARY, GEORGEANN
Entity Type:Individual
Prefix:
First Name:GEORGEANN
Middle Name:
Last Name:O'LEARY
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 1:2000 PENNINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 PENNINGTON ROAD
Practice Address - Street 2:THE COLLEGE OF NEW JERSEY HEALTH SERVICES
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628
Practice Address - Country:US
Practice Address - Phone:609-771-2889
Practice Address - Fax:609-637-5131
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07390200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP006151BOtherNURSE PRACTITIONER LICENS
NJ26NN07390200OtherNURSE PRACTITIONER LICENS