Provider Demographics
NPI:1841443496
Name:O'BRIEN, CHARLENE MARIE
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:MARIE
Last Name:O'BRIEN
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 1:2023 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14040-9617
Mailing Address - Country:US
Mailing Address - Phone:585-591-0670
Mailing Address - Fax:585-591-0670
Practice Address - Street 1:2023 CHURCH RD
Practice Address - Street 2:
Practice Address - City:DARIEN CENTER
Practice Address - State:NY
Practice Address - Zip Code:14040-9617
Practice Address - Country:US
Practice Address - Phone:585-591-0670
Practice Address - Fax:585-591-0670
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280003164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse