Individual
BRENDA O'HARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8911 LIBERTY MILLS RD, FORT WAYNE, IN 46804-6311
(260) 373-9465
(260) 266-9406
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036208A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100082420A
—
IN
Enumeration date
08/09/2006
Last updated
05/10/2023
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