Provider Demographics
NPI:1679038889
Name:O'BRIEN, DENISE A
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E TUDOR RD STE 6
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1036
Mailing Address - Country:US
Mailing Address - Phone:907-332-0065
Mailing Address - Fax:907-782-4522
Practice Address - Street 1:1515 E TUDOR RD STE 6
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1036
Practice Address - Country:US
Practice Address - Phone:907-332-0065
Practice Address - Fax:907-782-4522
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1659741890Medicaid