Healthcare Provider Details

I. General information

NPI: 1801970272
Provider Name (Legal Business Name): DENEEN MICHELE O'MARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE
HAMDEN CT
06518-3691
US

IV. Provider business mailing address

575 RIDGE RD
HAMDEN CT
06517-2515
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-4463
  • Fax:
Mailing address:
  • Phone: 203-288-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number002638
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: