Provider Demographics
NPI:1336276864
Name:O'BRIEN, MARY B (RN-C, FNP, MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:B
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:RN-C, FNP, MS
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Mailing Address - Street 1:1925 BRETON RD SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4810
Mailing Address - Country:US
Mailing Address - Phone:616-252-6030
Mailing Address - Fax:616-252-6035
Practice Address - Street 1:10383 42ND AVE
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8207
Practice Address - Country:US
Practice Address - Phone:616-252-6030
Practice Address - Fax:616-252-6035
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704107338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily