Healthcare Provider Details

I. General information

NPI: 1609299965
Provider Name (Legal Business Name): JEANNE MARIE OBRIEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W OKLAHOMA AVE SUITE 106
MILWAUKEE WI
53219-4303
US

IV. Provider business mailing address

5757 W OKLAHOMA AVE SUITE 106
MILWAUKEE WI
53219-4303
US

V. Phone/Fax

Practice location:
  • Phone: 414-810-4675
  • Fax: 414-810-4688
Mailing address:
  • Phone: 414-810-4675
  • Fax: 414-810-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number71464-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: