Healthcare Provider Details

I. General information

NPI: 1063635308
Provider Name (Legal Business Name): CHERYL LYNNETTE O'HALLORAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 PARALLEL PKWY
KANSAS CITY KS
66112-1689
US

IV. Provider business mailing address

12505 S HAGAN LN
OLATHE KS
66062-6075
US

V. Phone/Fax

Practice location:
  • Phone: 913-596-4860
  • Fax:
Mailing address:
  • Phone: 913-709-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number44446
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: