MEDICARE: MR. SEAN M. O'BRIEN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	226762	MA
2	367500000X	Certified Registered Nurse Anesthetist	045179-23-11	NH

General Provider Information

NPI Number	:	1932152725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEAN M. O'BRIEN CRNA

Provider Business Mailing Address
First Line	:	206 S SHORE RD
Second Line	:
City	:	NEW DURHAM
State	:	NH
Zip	:	03855-2119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3073 WHITE MTN HWY
Second Line	:	ANESTHESIA DEPARTMENT
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5001
Country	:	US
Telephone Number	:	603-356-5461
Fax Number	:	603-356-7651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/20/2007

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