Provider Demographics
NPI:1366692212
Name:O'BRIEN, DENISE ANN (NPP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ANN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:MISS
Other - First Name:DENISE
Other - Middle Name:ANN
Other - Last Name:ROUBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NPP
Mailing Address - Street 1:2573 S ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7336
Mailing Address - Country:US
Mailing Address - Phone:928-376-0220
Mailing Address - Fax:
Practice Address - Street 1:5312 RIO BRAVO DR STE 10
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9210
Practice Address - Country:US
Practice Address - Phone:575-915-1338
Practice Address - Fax:575-915-1819
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03604363LP0808X
NYF401029-1363LP0808X
AZAP3042363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93225008Medicaid
AZ349103OtherAHCCCS