Provider Demographics
NPI:1386977858
Name:O'HANLAN, MARY DOUGHERTY (APN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DOUGHERTY
Last Name:O'HANLAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:O'HANLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:8905 S PECOS RD
Mailing Address - Street 2:SUITE 23A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7147
Mailing Address - Country:US
Mailing Address - Phone:702-734-8311
Mailing Address - Fax:702-731-2871
Practice Address - Street 1:8905 S PECOS RD
Practice Address - Street 2:SUITE 23A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7147
Practice Address - Country:US
Practice Address - Phone:702-734-8311
Practice Address - Fax:702-731-2871
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner