Provider Demographics
NPI:1265936736
Name:O'REILLY, CASEY (NP)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CUNNINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1815
Mailing Address - Country:US
Mailing Address - Phone:978-810-4044
Mailing Address - Fax:
Practice Address - Street 1:195 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944
Practice Address - Country:US
Practice Address - Phone:978-526-4311
Practice Address - Fax:978-525-2342
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268440163W00000X, 363LF0000X
MAAG03180073363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health