Provider Demographics
NPI:1023647443
Name:OBRIEN, SHARON (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21017 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2015
Mailing Address - Country:US
Mailing Address - Phone:719-684-5678
Mailing Address - Fax:
Practice Address - Street 1:1413 W FILLMORE ST APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4716
Practice Address - Country:US
Practice Address - Phone:719-684-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041424785163WX0002X
IL209.022163041.424785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk