Healthcare Provider Details

I. General information

NPI: 1770958639
Provider Name (Legal Business Name): SHERRY O'BRIEN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S THOMPSON ST
FLAGSTAFF AZ
86001-8759
US

IV. Provider business mailing address

PO BOX 25816
MUNDS PARK AZ
86017-5816
US

V. Phone/Fax

Practice location:
  • Phone: 928-226-6400
  • Fax: 928-226-6411
Mailing address:
  • Phone: 480-466-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10273
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN170043
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: