Provider Demographics
NPI:1255538757
Name:OLEARY, THOMASINA (APRN)
Entity type:Individual
Prefix:MRS
First Name:THOMASINA
Middle Name:
Last Name:OLEARY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:THOMASINA
Other - Middle Name:
Other - Last Name:CRISORRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5400 DUNTEACHIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:410-802-2378
Mailing Address - Fax:
Practice Address - Street 1:5400 DUNTEACHIN DRIVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:410-869-8653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR136643163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult