Healthcare Provider Details

I. General information

NPI: 1972038305
Provider Name (Legal Business Name): ELLA OBROSKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALLEN ST
RUTLAND VT
05701-4560
US

IV. Provider business mailing address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

V. Phone/Fax

Practice location:
  • Phone: 802-747-3639
  • Fax: 802-747-6207
Mailing address:
  • Phone: 954-939-7179
  • Fax: 954-616-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101.
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: