Provider Demographics
NPI:1285750240
Name:O'BRIEN, MARY ELLEN (NMD, FNP)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:NMD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 E KEIM DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5847
Mailing Address - Country:US
Mailing Address - Phone:480-481-7872
Mailing Address - Fax:
Practice Address - Street 1:2127 E BASELINE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1537
Practice Address - Country:US
Practice Address - Phone:480-491-1716
Practice Address - Fax:480-491-5920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ97-514175F00000X
AZRN087042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily