Healthcare Provider Details

I. General information

NPI: 1154101889
Provider Name (Legal Business Name): OONAGH MARY OLLQUIST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 ROCKAWAY AVE
BROOKLYN NY
11212-5539
US

IV. Provider business mailing address

356 ROCKTOWN LAMBERTVILLE RD APT 3
LAMBERTVILLE NJ
08530-3312
US

V. Phone/Fax

Practice location:
  • Phone: 718-345-5000
  • Fax: 347-505-1942
Mailing address:
  • Phone: 908-894-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number768413
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: