Provider Demographics
NPI:1053488213
Name:O'BRIEN, SUSAN P (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 MIDDLE ST
Mailing Address - Street 2:ST. ANNE'S HOSPITAL - HUDNER ONCOLOGY
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1733
Mailing Address - Country:US
Mailing Address - Phone:508-675-5688
Mailing Address - Fax:508-675-5687
Practice Address - Street 1:795 MIDDLE ST
Practice Address - Street 2:ST. ANNE'S HOSPITAL - HUDNER ONCOLOGY
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1733
Practice Address - Country:US
Practice Address - Phone:508-675-5688
Practice Address - Fax:508-675-5687
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA136929363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2246Medicare ID - Type Unspecified
P00549Medicare UPIN