Provider Demographics
NPI:1154885879
Name:O'LEARY, CAITLIN L (ARNP, DNP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:L
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:ARNP, DNP
Other - Prefix:
Other - First Name:CATE
Other - Middle Name:L
Other - Last Name:O'LEARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP, DNP
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-520-5700
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-5017
Practice Address - Country:US
Practice Address - Phone:206-598-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61056809363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1154885879Medicaid