Healthcare Provider Details

I. General information

NPI: 1265936736
Provider Name (Legal Business Name): CASEY O'REILLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 SCHOOL ST
MANCHESTER MA
01944
US

IV. Provider business mailing address

47 CUNNINGHAM DR
SOUTH HAMILTON MA
01982-1815
US

V. Phone/Fax

Practice location:
  • Phone: 978-526-4311
  • Fax: 978-525-2342
Mailing address:
  • Phone: 978-810-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2268440
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG03180073
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2268440
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: