Healthcare Provider Details

I. General information

NPI: 1265497655
Provider Name (Legal Business Name): MICHAEL E OHARA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SW 9TH ST
ONTARIO OR
97914
US

IV. Provider business mailing address

5319 SW WESTGATE DR #241
PORTLAND OR
97221-2432
US

V. Phone/Fax

Practice location:
  • Phone: 541-881-7140
  • Fax:
Mailing address:
  • Phone: 503-297-7223
  • Fax: 503-297-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number096007764
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: