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General NPI Number Information
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NPI Number | 1790511798
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Entity Type | Individual
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Provider Name | OLIVIA ROSE OMALLEY
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 800 SPRUCE ST UNIT B
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City | PHILADELPHIA
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State | PA
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Zip | 19107-6192
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Country | US
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Telephone | 856-649-2810
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S 8TH ST STE 2L
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City | PHILADELPHIA
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State | PA
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Zip | 19106-4017
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Country | US
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Telephone | 267-322-7700
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 151784
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License Number State | PA
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