1144669136 NPI number — MRS. CINDY MARIE OBRIEN APNP, NP-C

Table of content: MRS. CINDY MARIE OBRIEN APNP, NP-C (NPI 1144669136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144669136 NPI number — MRS. CINDY MARIE OBRIEN APNP, NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBRIEN
Provider First Name:
CINDY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APNP, NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DORNACKER
Provider Other First Name:
CINDY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APNP, NP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144669136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5564 CHERRYWOOD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53027-9816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-305-6283
Provider Business Mailing Address Fax Number:
855-276-4412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10701 W RESEARCH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUWATOSA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-305-6283
Provider Business Practice Location Address Fax Number:
855-276-4412
Provider Enumeration Date:
06/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  532333 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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