Healthcare Provider Details

I. General information

NPI: 1386355170
Provider Name (Legal Business Name): BRIANNA MARIE O'BRIEN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ACADEMY RD
ALBANY NY
12208-3198
US

IV. Provider business mailing address

60 ACADEMY RD
ALBANY NY
12208-3198
US

V. Phone/Fax

Practice location:
  • Phone: 518-380-4766
  • Fax: 518-982-2972
Mailing address:
  • Phone: 518-380-4766
  • Fax: 518-982-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number342878-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: