Provider Demographics
NPI:1346341625
Name:OBRIEN, KATHLEEN GAIL (MS RN NP CS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GAIL
Last Name:OBRIEN
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Gender:F
Credentials:MS RN NP CS
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Mailing Address - Street 1:180 LAFAYETTE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-381-9714
Mailing Address - Fax:
Practice Address - Street 1:465 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527
Practice Address - Country:US
Practice Address - Phone:315-531-2400
Practice Address - Fax:315-531-2436
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF4005441363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q37137Medicare UPIN