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General NPI Number Information
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NPI Number | 1801805882
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Entity Type | Individual
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Provider Name | MARYANNE ELIZABETH O'HALLORAN MS, RN, CNS
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Gender | Female
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 965 E YOSEMITE AVE #18
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City | MANTECA
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State | CA
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Zip | 95336-5938
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Country | US
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Telephone | 209-545-9701
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Fax | 209-824-7264
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Provider Business Mailing Address
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Address Line | 4204 MEADOW BROOK LN
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City | SALIDA
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State | CA
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Zip | 95368-9729
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Country | US
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Telephone | 209-545-9701
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Fax | 209-239-4011
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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 | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 1124
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 260281
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License Number State | CA
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