Provider Demographics
NPI:1336803378
Name:O'BRIEN, ABIGAIL (APNP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1703
Mailing Address - Country:US
Mailing Address - Phone:608-219-8877
Mailing Address - Fax:
Practice Address - Street 1:3030 LAURA LN
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-1872
Practice Address - Country:US
Practice Address - Phone:888-688-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI234607-30163W00000X
WI11496-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse