Healthcare Provider Details

I. General information

NPI: 1982515516
Provider Name (Legal Business Name): REBECCA O'BRIEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 SPRING ST
MT PLEASANT WI
53406-2632
US

IV. Provider business mailing address

10995 116TH AVE UNIT 206
PLEASANT PRAIRIE WI
53158-1825
US

V. Phone/Fax

Practice location:
  • Phone: 262-504-3100
  • Fax:
Mailing address:
  • Phone: 262-515-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1913033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: