Healthcare Provider Details

I. General information

NPI: 1013158112
Provider Name (Legal Business Name): NICOLE FORTIER OBRIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDREN'S DRIVE
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

700 CHILDREN'S DRIVE
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-3437
  • Fax:
Mailing address:
  • Phone: 614-722-3437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35092698
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number35092698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: