Provider Demographics
NPI:1972808194
Name:OHARA, BERNADETTE CONLIN (CSAC)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:CONLIN
Last Name:OHARA
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28541-0752
Mailing Address - Country:US
Mailing Address - Phone:910-938-2004
Mailing Address - Fax:910-938-2018
Practice Address - Street 1:123 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5601
Practice Address - Country:US
Practice Address - Phone:910-938-2004
Practice Address - Fax:910-938-2018
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2137171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider