Provider Demographics
NPI:1841438678
Name:O'LEARY, PAULETTE MAE (LPN)
Entity type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:MAE
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DEERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3439
Mailing Address - Country:US
Mailing Address - Phone:218-464-0517
Mailing Address - Fax:
Practice Address - Street 1:24 DEERWOOD ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-3439
Practice Address - Country:US
Practice Address - Phone:218-464-0517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 049495-9164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse