Individual
MARY ALICE O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
200 FRONT ST, VESTAL, NY 13850-1559
(607) 658-1003
(607) 658-1006
Mailing address
58 LUSK ST, JOHNSON CITY, NY 13790-2541
(607) 763-6293
(607) 763-6717
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
526565
NY
363L00000X
Nurse Practitioner
Primary
F-334399
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02892717
—
NY
Enumeration date
11/02/2006
Last updated
02/16/2010
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