Provider Demographics
NPI:1780748913
Name:O'MALLEY, LINDA LEE (FNP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEE
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 S AYRES DR
Mailing Address - Street 2:
Mailing Address - City:NINEVEH
Mailing Address - State:IN
Mailing Address - Zip Code:46164-9081
Mailing Address - Country:US
Mailing Address - Phone:317-933-2815
Mailing Address - Fax:
Practice Address - Street 1:8620 S AYRES DR
Practice Address - Street 2:
Practice Address - City:NINEVEH
Practice Address - State:IN
Practice Address - Zip Code:46164-9081
Practice Address - Country:US
Practice Address - Phone:317-933-2815
Practice Address - Fax:317-933-2815
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000787A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN182060DMedicare ID - Type UnspecifiedPROVIDER NUMBER