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General NPI Number Information
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NPI Number | 1003975012
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Entity Type | Individual
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Provider Name | CHRISTA L O'MARA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 7701 W ASPERA BLVD
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City | GLENDALE
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State | AZ
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Zip | 85308-7947
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Country | US
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Telephone | 623-248-2108
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 W UTOPIA RD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85027-4172
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Country | US
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Telephone | 623-683-4462
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Fax | 480-882-5814
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP11351
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License Number State | AZ
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