Healthcare Provider Details

I. General information

NPI: 1003888330
Provider Name (Legal Business Name): NADINE OMALLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2668 ELM RD STE 1, BLDG C
CORTLAND OH
44410
US

IV. Provider business mailing address

77 E MIDLOTHIAN BLVD
YOUNGSTOWN OH
44507
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-5104
  • Fax: 330-395-2231
Mailing address:
  • Phone: 330-788-6506
  • Fax: 330-788-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number276038
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number05974
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: