Healthcare Provider Details

I. General information

NPI: 1811071335
Provider Name (Legal Business Name): JAMES AUGUSTINE OBRIEN CRNA MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE WAKE MED HOSP CRITICAL HEALTH SYSTEMS OF NORTH CAROLINA
RALEIGH NC
27610-9400
US

IV. Provider business mailing address

104 CONWAY COURT
CARY NC
27513-9400
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8820
  • Fax: 919-350-7385
Mailing address:
  • Phone: 919-467-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN157538
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number072176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: