Healthcare Provider Details

I. General information

NPI: 1740579416
Provider Name (Legal Business Name): COLETTE ROXANNE O'BRIEN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST SUITE 300
SAN FRANCISCO CA
94158-2334
US

IV. Provider business mailing address

1500 OWENS ST SUITE 300
SAN FRANCISCO CA
94158-2334
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-6234
  • Fax: 415-353-2811
Mailing address:
  • Phone: 415-514-6234
  • Fax: 415-353-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number493521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: