MEDICARE: MRS. DENISE ANN O'BRIEN NPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP-03604	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F401029-1	NY
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP3042	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	349103	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1366692212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE ANN O'BRIEN NPP

Provider Business Mailing Address
First Line	:	2573 S ARIZONA AVE
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-7336
Country	:	US
Telephone Number	:	928-376-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	5312 RIO BRAVO DR STE 10
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9210
Country	:	US
Telephone Number	:	575-915-1338
Fax Number	:	575-915-1819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	01/09/2024

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