Provider Demographics
NPI:1184627424
Name:O'LEARY, CAROL BAKER (RN, CS, NP-C)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:BAKER
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:RN, CS, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3933
Mailing Address - Country:US
Mailing Address - Phone:540-667-8187
Mailing Address - Fax:
Practice Address - Street 1:209 W CRISER RD
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2360
Practice Address - Country:US
Practice Address - Phone:540-636-2961
Practice Address - Fax:540-636-2933
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024066284363LF0000X
VA0015000631364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945212Medicaid
VA004945212Medicaid
VA890000129Medicare PIN