Provider Demographics
NPI:1093075673
Name:O'BRIEN, JENNIFER W (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:84 FOXBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-4315
Mailing Address - Country:US
Mailing Address - Phone:908-392-0381
Mailing Address - Fax:
Practice Address - Street 1:1 LIMBO LN
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-1871
Practice Address - Country:US
Practice Address - Phone:908-392-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH069710-23367500000X
MARN270285367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002850901Medicare PIN