Basic Information
| Provider Information | |||||||||
| NPI: | 1215100904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 BLYTHE BLVD | ||||||||
| Address2: | MEDICAL CENTER PLAZA, #602 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282035863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043555982 | ||||||||
| FaxNumber: | 7043552467 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 BLYTHE BLVD | ||||||||
| Address2: | MEDICAL CENTER PLAZA, #602 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282035863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043555982 | ||||||||
| FaxNumber: | 7043552467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 5003947 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.