Provider Demographics
NPI:1649577735
Name:O'LEARY, JANE E (NP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:E
Last Name:O'LEARY
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 1:106 HAVERFORD LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1995
Mailing Address - Country:US
Mailing Address - Phone:603-340-0167
Mailing Address - Fax:
Practice Address - Street 1:608 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206-1649
Practice Address - Country:US
Practice Address - Phone:716-858-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420306-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology