Provider Demographics
NPI:1366409401
Name:OBRIEN, LORI JEAN (RN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JEAN
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6717
Mailing Address - Country:US
Mailing Address - Phone:414-915-0118
Mailing Address - Fax:262-821-5043
Practice Address - Street 1:17350 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6717
Practice Address - Country:US
Practice Address - Phone:414-915-0118
Practice Address - Fax:262-821-5043
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI96321-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse