=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265872048
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN LOUISE O'BRIEN ANP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2013
-----------------------------------------------------
Last Update Date | 06/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PORT WASHINGTON BLVD
-----------------------------------------------------
City | ROSLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11576-1347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-562-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 BEDELL TER
-----------------------------------------------------
City | WEST HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11552-2444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-489-5499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F305840
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------