Provider Demographics
NPI:1952465726
Name:OBRIEN, ELLEN V (ANP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:V
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:417-1ST AVE
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-0365
Mailing Address - Country:US
Mailing Address - Phone:907-224-5205
Mailing Address - Fax:
Practice Address - Street 1:417-1ST AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-0365
Practice Address - Country:US
Practice Address - Phone:907-224-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL3490Medicaid
S70714Medicare UPIN
AKCL3490Medicaid