Provider Demographics
NPI:1710256516
Name:O'HARA, ANN (RN BSN)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:O'HARA
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 S GEDDES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-1222
Mailing Address - Country:US
Mailing Address - Phone:315-435-4091
Mailing Address - Fax:
Practice Address - Street 1:1607 S GEDDES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-1222
Practice Address - Country:US
Practice Address - Phone:315-435-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269978-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse