Healthcare Provider Details

I. General information

NPI: 1619680477
Provider Name (Legal Business Name): ELISHA ANN OBRIEN CPC, AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2022
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N HOLY NAMES CT
SPOKANE WA
99224-5803
US

IV. Provider business mailing address

2721 E 46TH AVE APT 2721
SPOKANE WA
99223-4465
US

V. Phone/Fax

Practice location:
  • Phone: 509-960-8632
  • Fax:
Mailing address:
  • Phone: 509-216-4394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number61333582
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: