MEDICARE: BARRY OHEARN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.353640	OH

General Provider Information

NPI Number	:	1417701830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY OHEARN RN

Provider Business Mailing Address
First Line	:	5790 ELM HILL DR
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-1946
Country	:	US
Telephone Number	:	440-715-3264
Fax Number	:

Provider Business Practice Location Address
First Line	:	5790 ELM HILL DR
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-1946
Country	:	US
Telephone Number	:	440-715-3264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	04/12/2024

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