Healthcare Provider Details

I. General information

NPI: 1518785930
Provider Name (Legal Business Name): JENNIFER OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/05/2024
Certification Date: 10/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 LEBANON ST
MELROSE MA
02176-3225
US

IV. Provider business mailing address

10 KATHY LN
WAKEFIELD MA
01880-4915
US

V. Phone/Fax

Practice location:
  • Phone: 781-979-3310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2263421
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2263421
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: