Provider Demographics
NPI:1639332844
Name:O'BRIEN, JOHN BASINGER (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BASINGER
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 CENTRAL ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4408
Mailing Address - Country:US
Mailing Address - Phone:360-773-6805
Mailing Address - Fax:
Practice Address - Street 1:6981 LITTLEROCK RD SW
Practice Address - Street 2:SUITE 101
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7226
Practice Address - Country:US
Practice Address - Phone:360-943-3633
Practice Address - Fax:960-528-4643
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant