Provider Demographics
NPI:1760815864
Name:O'BRIEN, CHRISTINE LAURIE (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LAURIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 POSEIDON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9686
Mailing Address - Country:US
Mailing Address - Phone:631-875-9500
Mailing Address - Fax:
Practice Address - Street 1:43 POSEIDON RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9686
Practice Address - Country:US
Practice Address - Phone:631-875-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401633-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner