Healthcare Provider Details

I. General information

NPI: 1437713930
Provider Name (Legal Business Name): MOLLY K O'BRIEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0S036 CHURCH ST STE 200
WINFIELD IL
60190-1203
US

IV. Provider business mailing address

0S036 CHURCH ST STE 200
WINFIELD IL
60190-1203
US

V. Phone/Fax

Practice location:
  • Phone: 630-315-6500
  • Fax: 630-315-6519
Mailing address:
  • Phone: 630-315-6500
  • Fax: 630-315-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085007099
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085007099
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: