Provider Demographics
NPI:1972810752
Name:O'BRIEN, ALYSIA S (FNP)
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:S
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67D MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1831
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:866-389-2727
Practice Address - Street 1:1 CVS DR
Practice Address - Street 2:MINUTECLINIC CREDENTIALING 200HCD
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-6146
Practice Address - Country:US
Practice Address - Phone:401-770-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN265505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily