Healthcare Provider Details

I. General information

NPI: 1023647443
Provider Name (Legal Business Name): SHARON OBRIEN DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 W FILLMORE ST APT 2
CHICAGO IL
60607-4716
US

IV. Provider business mailing address

21017 STRATFORD CT
MOKENA IL
60448-2015
US

V. Phone/Fax

Practice location:
  • Phone: 719-684-5678
  • Fax:
Mailing address:
  • Phone: 719-684-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number041424785
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.022163041.424785
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: