Healthcare Provider Details

I. General information

NPI: 1043327679
Provider Name (Legal Business Name): KATHLEEN OHANLON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN DIEGO VETERANS HEALTHCARE SYSTEM 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

3244 OLD HEATHER RD
SAN DIEGO CA
92111-7716
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax: 858-642-6242
Mailing address:
  • Phone: 858-552-8585
  • Fax: 858-642-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR14524
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: