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General NPI Number Information
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NPI Number | 1033241708
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Entity Type | Individual
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Provider Name | ILSE O'BRIEN RD
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 6501 LOISDALE CT
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1826
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Country | US
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Telephone | 703-922-1000
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Fax | 301-816-7170
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Provider Business Mailing Address
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Address Line | 2101 E JEFFERSON ST KAISER PERMANENTE
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-7405
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Fax | 301-388-1740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 609194
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License Number State | VA
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