Provider Demographics
NPI:1457485328
Name:O'BRIEN, JULIE L (APN, CNS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:APN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 N ROUTE 91
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-683-5051
Mailing Address - Fax:309-683-5428
Practice Address - Street 1:8600 N STATE ROUTE 91
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9541
Practice Address - Country:US
Practice Address - Phone:309-683-5409
Practice Address - Fax:309-683-5428
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002981364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL809840OtherMEDICARE GROUP PTAN
626560Medicare ID - Type Unspecified
ILK53433Medicare PIN
P00682Medicare UPIN