Healthcare Provider Details

I. General information

NPI: 1285750240
Provider Name (Legal Business Name): MARY ELLEN O'BRIEN NMD, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 E BASELINE RD SUITE 103
TEMPE AZ
85283-1537
US

IV. Provider business mailing address

8325 E KEIM DR
SCOTTSDALE AZ
85250-5847
US

V. Phone/Fax

Practice location:
  • Phone: 480-491-1716
  • Fax: 480-491-5920
Mailing address:
  • Phone: 480-481-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN087042
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number97-514
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: