Healthcare Provider Details

I. General information

NPI: 1982301859
Provider Name (Legal Business Name): WILLIAM OHARA PHMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 W EPHESUS CT
TUCSON AZ
85742-2209
US

IV. Provider business mailing address

2242 W EPHESUS CT
TUCSON AZ
85742-2209
US

V. Phone/Fax

Practice location:
  • Phone: 480-980-7309
  • Fax:
Mailing address:
  • Phone: 480-980-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number287014
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: