Healthcare Provider Details

I. General information

NPI: 1316330889
Provider Name (Legal Business Name): ROBERTA O'BRIEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 STONECREEK BLVD SUITE E
CINCINNATI OH
45251-1468
US

IV. Provider business mailing address

3645 STONECREEK BLVD SUITE E
CINCINNATI OH
45251-1468
US

V. Phone/Fax

Practice location:
  • Phone: 513-687-0500
  • Fax: 513-598-1107
Mailing address:
  • Phone: 513-687-0500
  • Fax: 513-598-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009282
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: