Healthcare Provider Details

I. General information

NPI: 1861412215
Provider Name (Legal Business Name): KATHLYN O BRIEN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 OCEAN BAY BLVD
LAVALLETTE NJ
08735-1620
US

IV. Provider business mailing address

212 OCEAN BAY BLVD
LAVALLETTE NJ
08735-1620
US

V. Phone/Fax

Practice location:
  • Phone: 732-674-1553
  • Fax: 732-793-0794
Mailing address:
  • Phone: 732-674-1553
  • Fax: 732-793-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR06727600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00320900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: