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General NPI Number Information
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NPI Number | 1962873042
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Entity Type | Individual
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Provider Name | LISA ANNETTE O'BRIEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 1215 EAST MICHIGAN AVENUE SPARROW HOSPITAL, DIVISION OF NEONATOLOGY
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City | LANSING
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State | MI
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Zip | 48912
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Country | US
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Telephone | 517-364-2670
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Fax |
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Provider Business Mailing Address
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Address Line | 804 SERVICE RD STE A109F
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City | EAST LANSING
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State | MI
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Zip | 48824-7015
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Country | US
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Telephone | 517-884-2976
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Fax | 517-432-3928
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601003345
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License Number State | MI
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