Provider Demographics
NPI:1215100904
Name:O'BRIEN, BEVERLY MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BLYTHE BLVD
Mailing Address - Street 2:MEDICAL CENTER PLAZA, #602
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5863
Mailing Address - Country:US
Mailing Address - Phone:704-355-5982
Mailing Address - Fax:704-355-2467
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:MEDICAL CENTER PLAZA, #602
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5863
Practice Address - Country:US
Practice Address - Phone:704-355-5982
Practice Address - Fax:704-355-2467
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003947363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health