Provider Demographics
NPI:1104815539
Name:O'BRIEN, CAROLYN M (NP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-0383
Mailing Address - Country:US
Mailing Address - Phone:508-530-3140
Mailing Address - Fax:508-530-3142
Practice Address - Street 1:31 DANIELS ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1103
Practice Address - Country:US
Practice Address - Phone:508-530-3140
Practice Address - Fax:508-538-3142
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190716363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0384950Medicaid
MANP216001Medicare PIN