Provider Demographics
NPI:1104611490
Name:O'BRIEN, ALEJANDRA
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82635-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WY
Practice Address - Zip Code:82635-5002
Practice Address - Country:US
Practice Address - Phone:307-305-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health