Provider Demographics
NPI:1265216741
Name:O'MARA, LELAINIA ANN (RN)
Entity type:Individual
Prefix:MS
First Name:LELAINIA
Middle Name:ANN
Last Name:O'MARA
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 1:1357 OVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2414
Mailing Address - Country:US
Mailing Address - Phone:304-365-4477
Mailing Address - Fax:
Practice Address - Street 1:419 MORGANTOWN ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1095
Practice Address - Country:US
Practice Address - Phone:304-329-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT317966-3102163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health