Provider Demographics
NPI:1427644210
Name:O'HANLON, VICTORIA (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:O'HANLON
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:MARSEILLES
Mailing Address - State:IL
Mailing Address - Zip Code:61341-1529
Mailing Address - Country:US
Mailing Address - Phone:815-617-9999
Mailing Address - Fax:
Practice Address - Street 1:380 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341-1529
Practice Address - Country:US
Practice Address - Phone:815-617-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021915041326992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily