Basic Information
| Provider Information | |||||||||
| NPI: | 1821477795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'MARA | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | THERESA FERRO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 W. FIREWEED LANE | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077700862 | ||||||||
| FaxNumber: | 9077701730 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 W. FIREWEED LANE | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077700862 | ||||||||
| FaxNumber: | 9077701730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2015 | ||||||||
| LastUpdateDate: | 05/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH0200X | 38620 | AK | Y | Nursing Service Providers | Registered Nurse | Home Health |
No ID Information.