Healthcare Provider Details

I. General information

NPI: 1427675222
Provider Name (Legal Business Name): JAMES OHARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11221 N 28TH DR BLDG N28TH
PHOENIX AZ
85029-5615
US

IV. Provider business mailing address

11221 N 28TH DR BLDG E
PHOENIX AZ
85029-5615
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-2233
  • Fax:
Mailing address:
  • Phone: 602-997-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number261420
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: