Provider Demographics
NPI:1770576373
Name:O'BRIEN, NANCY COLLINS (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:COLLINS
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:OTTUMWA PEDIATRICS
Mailing Address - Street 2:931 PENNSYLVANIA AVE
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501
Mailing Address - Country:US
Mailing Address - Phone:641-684-3000
Mailing Address - Fax:641-684-2469
Practice Address - Street 1:OTTUMWA PEDIATRICS
Practice Address - Street 2:931 PENNSYLVANIA AVE
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-684-3000
Practice Address - Fax:641-684-2469
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29316208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42068106032OtherJOHN DEERE HEALTH
IA0098012Medicaid
IAG004OtherTRIWEST
IA37875OtherIOWA HEALTH SOLUTIONS
IA51222OtherWELLMARK INC BCBS OF IA
IA51222Medicare ID - Type Unspecified
IA0098012Medicaid