Provider Demographics
NPI:1932423761
Name:O'BRIEN, SANDRA (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
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 1:5912 HUBBARD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4823
Mailing Address - Country:US
Mailing Address - Phone:301-770-1818
Mailing Address - Fax:301-576-7736
Practice Address - Street 1:5912 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4823
Practice Address - Country:US
Practice Address - Phone:301-770-1818
Practice Address - Fax:301-576-7736
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR080218363LF0000X, 364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR080218OtherLICENSE