Provider Demographics
NPI:1144224684
Name:OBRIEN, ANITA P (NP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:P
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4267 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3527
Mailing Address - Country:US
Mailing Address - Phone:414-873-3440
Mailing Address - Fax:
Practice Address - Street 1:4267 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3527
Practice Address - Country:US
Practice Address - Phone:414-873-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2392363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41188300Medicaid
WI0778Medicare ID - Type Unspecified
S66070Medicare UPIN