Provider Demographics
NPI:1699384164
Name:OBRIEN, NICOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9737 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9001
Mailing Address - Country:US
Mailing Address - Phone:716-949-7810
Mailing Address - Fax:
Practice Address - Street 1:9737 TEXAS ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9001
Practice Address - Country:US
Practice Address - Phone:716-949-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY796542163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty