Healthcare Provider Details

I. General information

NPI: 1053471334
Provider Name (Legal Business Name): CAROLYN O'LEARY MOSIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 OVERBROOK ST
FALLS CHURCH VA
22043-1944
US

IV. Provider business mailing address

6440 OVERBROOK ST
FALLS CHURCH VA
22043-1944
US

V. Phone/Fax

Practice location:
  • Phone: 703-599-9180
  • Fax:
Mailing address:
  • Phone: 703-599-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001168291
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: