Provider Demographics
NPI:1861412215
Name:O BRIEN, KATHLYN (RNFA)
Entity type:Individual
Prefix:
First Name:KATHLYN
Middle Name:
Last Name:O BRIEN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 OCEAN BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAVALLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:08735-1620
Mailing Address - Country:US
Mailing Address - Phone:732-674-1553
Mailing Address - Fax:732-793-0794
Practice Address - Street 1:212 OCEAN BAY BLVD
Practice Address - Street 2:
Practice Address - City:LAVALLETTE
Practice Address - State:NJ
Practice Address - Zip Code:08735-1620
Practice Address - Country:US
Practice Address - Phone:732-674-1553
Practice Address - Fax:732-793-0794
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR06727600163WR0006X
NJ26NJ00320900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant