Provider Demographics
NPI:1467713008
Name:O'BRIEN, COLEEN E (PNP)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:E
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:COLEEN
Other - Middle Name:E
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-631-0002
Mailing Address - Fax:704-631-0002
Practice Address - Street 1:1001 BLYTHE BLVD.
Practice Address - Street 2:SUITE 200D
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6215
Practice Address - Country:US
Practice Address - Phone:704-373-1813
Practice Address - Fax:704-373-1813
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN173314363LP0200X
AZAP4492363LP0200X
NC300221363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ710871Medicaid