Healthcare Provider Details

I. General information

NPI: 1356424113
Provider Name (Legal Business Name): EILEEN H O'BRIEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 VETERANS HWY
BRISTOL PA
19007-2506
US

IV. Provider business mailing address

721 VETERANS HWY
BRISTOL PA
19007-2506
US

V. Phone/Fax

Practice location:
  • Phone: 610-481-0481
  • Fax: 610-481-0486
Mailing address:
  • Phone: 610-481-0481
  • Fax: 610-481-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberTP006860G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: