Provider Demographics
NPI:1780670992
Name:O'BRIEN, RITA (CRNA)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RIVERSIDE ASSOCIATES
Mailing Address - Street 2:40 FRONT STREET
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-722-7264
Mailing Address - Fax:607-722-7869
Practice Address - Street 1:RIVERSIDE ASSOCIATES
Practice Address - Street 2:40 FRONT STREET
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-722-7264
Practice Address - Fax:607-722-7869
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325919163W00000X
NY39522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
R54847Medicare UPIN
34565WMedicare ID - Type Unspecified