Provider Demographics
NPI:1467490573
Name:O'BRIEN, MAUREEN ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HARBORVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-4601
Mailing Address - Country:US
Mailing Address - Phone:262-909-1380
Mailing Address - Fax:
Practice Address - Street 1:68 HARBORVIEW DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-4601
Practice Address - Country:US
Practice Address - Phone:262-909-1380
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70004163WH0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39894400Medicaid