Provider Demographics
NPI:1215097415
Name:O'HANLON, LORETTA (NURSE PRACTIONER)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:
Last Name:O'HANLON
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2006
Mailing Address - Country:US
Mailing Address - Phone:828-252-5795
Mailing Address - Fax:828-252-5646
Practice Address - Street 1:16 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2006
Practice Address - Country:US
Practice Address - Phone:828-252-5795
Practice Address - Fax:828-252-5646
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC156573364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0305815-01OtherANCC NATIONAL NUMBER
0366661-34OtherANCC NATIONAL NUMBER
NC6005014Medicaid