Provider Demographics
NPI:1629804950
Name:O'HARA, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:O'HARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3104
Mailing Address - Country:US
Mailing Address - Phone:631-667-0388
Mailing Address - Fax:631-968-7705
Practice Address - Street 1:1231 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3104
Practice Address - Country:US
Practice Address - Phone:631-667-0388
Practice Address - Fax:631-968-7705
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311818363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health