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General NPI Number Information
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NPI Number | 1972808194
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Entity Type | Individual
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Provider Name | BERNADETTE CONLIN OHARA CSAC
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Gender | Female
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 123 HENDERSON DR
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5601
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Country | US
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Telephone | 910-938-2004
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Fax | 910-938-2018
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Provider Business Mailing Address
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Address Line | PO BOX 752
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City | JACKSONVILLE
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State | NC
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Zip | 28541-0752
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Country | US
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Telephone | 910-938-2004
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Fax | 910-938-2018
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 2137
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License Number State | NC
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