Provider Demographics
NPI:1598879793
Name:O'BRIEN, JEANNINE A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:A
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 RATTLESNAKE RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-9722
Mailing Address - Country:US
Mailing Address - Phone:916-663-2100
Mailing Address - Fax:916-663-2103
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-200-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14186363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00185911OtherRAILROAD MEDICARE
CAZZZ31975ZMedicare PIN
CAP33148Medicare UPIN