Healthcare Provider Details

I. General information

NPI: 1346341625
Provider Name (Legal Business Name): KATHLEEN GAIL OBRIEN MS RN NP CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 NORTH MAIN STREET
PENN YAN NY
14527
US

IV. Provider business mailing address

180 LAFAYETTE PARKWAY
ROCHESTER NY
14625
US

V. Phone/Fax

Practice location:
  • Phone: 315-531-2400
  • Fax: 315-531-2436
Mailing address:
  • Phone: 585-381-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF4005441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: