MEDICARE: KATHLEEN L O'MARA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	334094	NY

General Provider Information

NPI Number	:	1689750697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN L O'MARA FNP

Provider Business Mailing Address
First Line	:	314 TONJES RD
Second Line	:
City	:	CALLICOON
State	:	NY
Zip	:	12723-5742
Country	:	US
Telephone Number	:	845-482-3514
Fax Number	:	845-482-3507

Provider Business Practice Location Address
First Line	:	43 MAIN ST.
Second Line	:
City	:	LIVINGSTON MANOR
State	:	NY
Zip	:	12758-0800
Country	:	US
Telephone Number	:	845-439-8731
Fax Number	:	845-439-8370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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