Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3006723 | KY |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71003264A | IN |
NPI | 1003127358 |
---|---|
Provider Name | Harold Dean O'brien |
First Address | New Albany, IN 47150-9426 |
Second Address | Louisville, KY 40204-1353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000668876 | ANTHEM (01) | IN |