Provider Demographics
NPI:1306110432
Name:O'LEARY, MARY T (RN BS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:T
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:RN BS
Other - Prefix:
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Mailing Address - Street 1:77 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1758
Mailing Address - Country:US
Mailing Address - Phone:718-479-4661
Mailing Address - Fax:718-454-5337
Practice Address - Street 1:7410 COMMONWEALTH BLVD
Practice Address - Street 2:ROOM 128
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1800
Practice Address - Country:US
Practice Address - Phone:718-479-4661
Practice Address - Fax:718-454-5337
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY451100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse