Provider Demographics
NPI:1700491057
Name:OBRIEN, JESSICA MARIE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:OBRIEN
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:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82635-0225
Mailing Address - Country:US
Mailing Address - Phone:307-315-8468
Mailing Address - Fax:
Practice Address - Street 1:204 N KIEFFER ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WY
Practice Address - Zip Code:82635-5017
Practice Address - Country:US
Practice Address - Phone:307-315-8468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator