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General NPI Number Information
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NPI Number | 1396301685
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Entity Type | Individual
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Provider Name | KATELYN PETICCA O'BRIEN RN, MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 3525 KAREN PKWY APT 204
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City | WATERFORD
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State | MI
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Zip | 48328-4609
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Country | US
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Telephone | 248-568-0692
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Fax |
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Provider Business Mailing Address
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Address Line | 3525 KAREN PKWY APT 204
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City | WATERFORD
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State | MI
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Zip | 48328-4609
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Country | US
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Telephone | 248-568-0692
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704300190
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License Number State | MI
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