Provider Demographics
NPI:1821120635
Name:OBRIEN, KATHLEEN RAE (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RAE
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:RAE
Other - Last Name:PLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:701 WEST WETMORE ROAD
Mailing Address - Street 2:AMPHITHEATER PUBLIC ROADS
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5237
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 WEST WETMORE ROAD
Practice Address - Street 2:AMPHITHEATER PUBLIC ROADS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5237
Practice Address - Fax:520-696-5067
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN028354163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ752825Medicaid