Healthcare Provider Details

I. General information

NPI: 1508926395
Provider Name (Legal Business Name): GEORGEANN O'LEARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PENNINGTON ROAD THE COLLEGE OF NEW JERSEY HEALTH SERVICES
EWING NJ
08628
US

IV. Provider business mailing address

2000 PENNINGTON ROAD
EWING NJ
08628
US

V. Phone/Fax

Practice location:
  • Phone: 609-771-2889
  • Fax: 609-637-5131
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN07390200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: