Provider Demographics
NPI:1619680477
Name:OBRIEN, ELISHA ANN (CPC, AAC)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:ANN
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:CPC, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 E 46TH AVE APT 2721
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4465
Mailing Address - Country:US
Mailing Address - Phone:509-216-4394
Mailing Address - Fax:
Practice Address - Street 1:1960 N HOLY NAMES CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-5803
Practice Address - Country:US
Practice Address - Phone:509-960-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171M00000X
WA61333582171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator