MEDICARE: MRS. JENNA LEIGH O'BRIEN RN

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	163W00000X	Registered Nurse	041480863	IL
2	367500000X	Certified Registered Nurse Anesthetist	209030931	IL

General Provider Information

NPI Number	:	1710665674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA LEIGH O'BRIEN RN

Provider Business Mailing Address
First Line	:	3109 N KARLOV AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-5436
Country	:	US
Telephone Number	:	614-746-7020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 N KARLOV AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-5436
Country	:	US
Telephone Number	:	614-746-7020
Fax Number	:

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

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	11/14/2024

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