Doctor Name: | MRS. MARY B O'BRIEN |
NPI Number: | 1336276864 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN-C, FNP, MS |
License Number: | 4704107338 |
Business Practice Address: | 10383 42nd Ave Allendale, MI - 494018207 |
Business Phone Number: | 6162526030 |
Business Fax Number: | 6162526035 |
Mailing Address: | 1925 Breton Rd Se, Suite 201 GRAND RAPIDS |
State: | MI |
Postal Code: | 495064810 |
Phone Number: | 6162526030 |
Fax Number: | 6162526035 |
NPI Enumeration Date: | 02/28/2007 |
NPI Last Update Date: | 02/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704107338 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |