Provider Demographics
NPI:1619207461
Name:O'BRIEN, ROBERTA ANN (RN, CDOE)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ANN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:RN, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 JASON DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4939
Mailing Address - Country:US
Mailing Address - Phone:401-578-4560
Mailing Address - Fax:508-819-4939
Practice Address - Street 1:7 JASON DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4939
Practice Address - Country:US
Practice Address - Phone:401-578-4560
Practice Address - Fax:508-819-4939
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN22133163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator