Provider Demographics
NPI:1154330751
Name:O'BRIEN, CATHERINE M (FNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8009
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-8009
Mailing Address - Country:US
Mailing Address - Phone:315-786-1924
Mailing Address - Fax:315-786-0823
Practice Address - Street 1:26495 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1749
Practice Address - Country:US
Practice Address - Phone:315-786-1924
Practice Address - Fax:315-786-0823
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332600-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02011310Medicaid
NY02011310Medicaid
NYRA2079Medicare PIN