Healthcare Provider Details

I. General information

NPI: 1770295818
Provider Name (Legal Business Name): ABIGAIL MARIE O'BRIEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 07/06/2024
Certification Date: 07/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BUSINESS PARK DR STE A
TRAVERSE CITY MI
49686-8683
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704306307
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: