Provider Demographics
NPI:1952053639
Name:O'BRIEN, MARIA JENELLE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JENELLE
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 1:103 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-1017
Mailing Address - Country:US
Mailing Address - Phone:330-394-8831
Mailing Address - Fax:330-373-0340
Practice Address - Street 1:103 W MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1017
Practice Address - Country:US
Practice Address - Phone:330-394-8831
Practice Address - Fax:330-373-0340
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.348747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse