Healthcare Provider Details

I. General information

NPI: 1861071797
Provider Name (Legal Business Name): DOMINIKA OBRIEN APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLD MARLTON PIKE W
MARLTON NJ
08053
US

IV. Provider business mailing address

100 W OLD MARLTON PIKE
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 856-393-2440
  • Fax:
Mailing address:
  • Phone: 856-596-3000
  • Fax: 856-596-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN628835
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NR1958830
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: