Healthcare Provider Details

I. General information

NPI: 1548046501
Provider Name (Legal Business Name): JENNIFER OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 MILLTOWN RD
WILMINGTON DE
19808-4011
US

IV. Provider business mailing address

2625 BARDELL DR
WILMINGTON DE
19808-3071
US

V. Phone/Fax

Practice location:
  • Phone: 302-992-5504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL1-0033579
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: