Provider Demographics
NPI:1801805882
Name:O'HALLORAN, MARYANNE ELIZABETH (MS, RN, CNS)
Entity type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:ELIZABETH
Last Name:O'HALLORAN
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Gender:F
Credentials:MS, RN, CNS
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Mailing Address - Street 1:4204 MEADOW BROOK LN
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-9729
Mailing Address - Country:US
Mailing Address - Phone:209-545-9701
Mailing Address - Fax:209-239-4011
Practice Address - Street 1:965 E YOSEMITE AVE
Practice Address - Street 2:#18
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5938
Practice Address - Country:US
Practice Address - Phone:209-545-9701
Practice Address - Fax:209-824-7264
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2017-02-20
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Provider Licenses
StateLicense IDTaxonomies
CA260281163W00000X
CA1124364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26705ZMedicare ID - Type Unspecified