Provider Demographics
NPI:1962873042
Name:O'BRIEN, LISA ANNETTE (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNETTE
Last Name:O'BRIEN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:STE A109F
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:1215 EAST MICHIGAN AVENUE
Practice Address - Street 2:SPARROW HOSPITAL, DIVISION OF NEONATOLOGY
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-364-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2019-02-20
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Provider Licenses
StateLicense IDTaxonomies
MI5601003345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant