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NPI Code Detail

MEDICARE: MS. NANCY M. O'HARA M.A., LP

MEDICARE: MS. NANCY M. O'HARA M.A., LP
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
1103T00000XPsychologistLP 1610MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NONEOTHERNONE

General Provider Information

NPI Number : 1922126416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANCY M. O'HARA M.A., LP
Provider Business Mailing Address
First Line : 2712 FREMONT AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-1122
Country : US
Telephone Number : 612-872-8218
Fax Number : 612-874-8885
Provider Business Practice Location Address
First Line : 2712 FREMONT AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-1122
Country : US
Telephone Number : 612-872-8218
Fax Number : 612-874-8885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 07/08/2007

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