Healthcare Provider Details

I. General information

NPI: 1588802565
Provider Name (Legal Business Name): MARY K OGARA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 CHIPPENDALE ST
PHILADELPHIA PA
19136-3604
US

IV. Provider business mailing address

4240 CHIPPENDALE ST
PHILADELPHIA PA
19136-3604
US

V. Phone/Fax

Practice location:
  • Phone: 215-332-4176
  • Fax: 215-332-4176
Mailing address:
  • Phone: 215-332-4176
  • Fax: 215-332-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN094691L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: