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General NPI Number Information
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NPI Number | 1770958639
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Entity Type | Individual
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Provider Name | SHERRY O'BRIEN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 2000 S THOMPSON ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-8759
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Country | US
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Telephone | 928-226-6400
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Fax | 928-226-6411
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Provider Business Mailing Address
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Address Line | PO BOX 25816
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City | MUNDS PARK
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State | AZ
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Zip | 86017-5816
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Country | US
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Telephone | 480-466-1311
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN170043
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP10273
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License Number State | AZ
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