Provider Demographics
NPI:1245310754
Name:O'BRIEN, COLLEEN PATRICE (LAC)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:PATRICE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 BEAR AVE S
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7003
Mailing Address - Country:US
Mailing Address - Phone:651-330-9392
Mailing Address - Fax:
Practice Address - Street 1:4801 HIGHWAY 61 N STE 307
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-2753
Practice Address - Country:US
Practice Address - Phone:612-741-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1459171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist