Provider Demographics
NPI:1972170512
Name:O'BRIEN, ADRIAN R (DEM)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:R
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 BLACK RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3776
Mailing Address - Country:US
Mailing Address - Phone:419-612-6779
Mailing Address - Fax:
Practice Address - Street 1:4149 BLACK RIVER CIR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3776
Practice Address - Country:US
Practice Address - Phone:419-612-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty