Provider Demographics
NPI:1518165687
Name:OMALIA, MARY C (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:OMALIA
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 1:495 COOPER RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8780
Mailing Address - Country:US
Mailing Address - Phone:614-839-5555
Mailing Address - Fax:614-839-5100
Practice Address - Street 1:495 COOPER RD
Practice Address - Street 2:SUITE 420
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8780
Practice Address - Country:US
Practice Address - Phone:614-839-5555
Practice Address - Fax:614-839-5100
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP03656163W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN-159772OtherNURSING LICENSE