Provider Demographics
NPI:1841517133
Name:O'BRIEN, CAROL
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:MARZELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 HALLOCK RD SUITE 201
Mailing Address - Street 2:INTERIM HEALTHCARE
Mailing Address - City:STONYBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3073
Mailing Address - Country:US
Mailing Address - Phone:631-689-8920
Mailing Address - Fax:631-689-8955
Practice Address - Street 1:207 HALLOCK RD SUITE 201
Practice Address - Street 2:
Practice Address - City:STONYBROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3073
Practice Address - Country:US
Practice Address - Phone:631-689-8920
Practice Address - Fax:631-689-8955
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376109-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse