Provider Demographics
NPI:1659687135
Name:O'BRIEN, CARRIE LYNN (LPN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6481 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-9547
Mailing Address - Country:US
Mailing Address - Phone:440-422-3032
Mailing Address - Fax:
Practice Address - Street 1:6481 HUNTER RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-9547
Practice Address - Country:US
Practice Address - Phone:440-422-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-105194164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse