=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265253439
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA O'BRIEN RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2024
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 237 BROOK VILLAGE RD APT 2
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03062-2851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-438-1928
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 237 BROOK VILLAGE RD APT 2
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03062-2851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-438-1928
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | 085015-21
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------