Healthcare Provider Details

I. General information

NPI: 1326795022
Provider Name (Legal Business Name): BRIGID ALYSHE O'BRIEN BMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 TIERRA ST NE APT C
ALBUQUERQUE NM
87111-7016
US

IV. Provider business mailing address

5904 TIERRA ST NE APT C
ALBUQUERQUE NM
87111-7016
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: