Healthcare Provider Details

I. General information

NPI: 1265216741
Provider Name (Legal Business Name): LELAINIA ANN O'MARA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MORGANTOWN ST
KINGWOOD WV
26537-1095
US

IV. Provider business mailing address

1357 OVERHILL RD
FAIRMONT WV
26554-2414
US

V. Phone/Fax

Practice location:
  • Phone: 304-329-3565
  • Fax:
Mailing address:
  • Phone: 304-365-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number317966-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: