Provider Demographics
NPI:1386451615
Name:O'LEARY, MIRANDA CARSON (NNP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CARSON
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:ALEXIS
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2008 KELSEY BAY CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5346
Mailing Address - Country:US
Mailing Address - Phone:757-325-7822
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24192047363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care