Provider Demographics
NPI:1255909651
Name:O'BRIEN, KIRSTEN
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
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 1:9810 RASTRO WAY
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:CA
Mailing Address - Zip Code:95329-9697
Mailing Address - Country:US
Mailing Address - Phone:209-648-6814
Mailing Address - Fax:
Practice Address - Street 1:9810 RASTRO WAY
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:CA
Practice Address - Zip Code:95329-9697
Practice Address - Country:US
Practice Address - Phone:209-648-6814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685129164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse