Provider Demographics
NPI:1992380752
Name:O'LEARY, SHERRY (RN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5221
Mailing Address - Country:US
Mailing Address - Phone:928-669-6168
Mailing Address - Fax:
Practice Address - Street 1:131 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5221
Practice Address - Country:US
Practice Address - Phone:928-669-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN079569163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0353778OtherOTHER ID NUMBER COMMERCIAL
CA1053355305Medicaid