Individual
MRS. OLIVIA O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6 GLEN DR, LAKE RONKONKOMA, NY 11779-1506
(631) 774-9793
Mailing address
6 GLEN DR, LAKE RONKONKOMA, NY 11779-1506
(631) 774-9793
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F383479-01
NY
Other
Enumeration date
01/12/2023
Last updated
01/12/2023
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