Provider Demographics
NPI:1598082653
Name:O'MALLEY, EILEEN (LPN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR
Mailing Address - State:WI
Mailing Address - Zip Code:54209-8910
Mailing Address - Country:US
Mailing Address - Phone:920-868-2540
Mailing Address - Fax:
Practice Address - Street 1:4635 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR
Practice Address - State:WI
Practice Address - Zip Code:54209-8910
Practice Address - Country:US
Practice Address - Phone:920-868-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26165-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse