Provider Demographics
NPI:1598187338
Name:OMALIA, THERESA (CNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:OMALIA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:EADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8805 BRECKSVILLE RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1952
Mailing Address - Country:US
Mailing Address - Phone:440-262-2300
Mailing Address - Fax:
Practice Address - Street 1:8805 BRECKSVILLE RD UNIT 2
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1952
Practice Address - Country:US
Practice Address - Phone:440-262-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN395426163W00000X
OHAPRN.CNP.023934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty