Provider Demographics
NPI:1417742412
Name:O'BRIEN, JORDYN (RH, PHN)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:
Credentials:RH, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1404
Mailing Address - Country:US
Mailing Address - Phone:218-576-5085
Mailing Address - Fax:218-576-5085
Practice Address - Street 1:320 W 2ND ST # 7W
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1404
Practice Address - Country:US
Practice Address - Phone:218-576-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2523249163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse