Provider Demographics
NPI:1265450381
Name:O'DONNELL, KATHLEEN (RN, MSN, CRRN, ANP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:RN, MSN, CRRN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MOUNT KEMBLE AVE
Mailing Address - Street 2:THEBAUD BUILDING, FOURTH FLOOR
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5155
Mailing Address - Country:US
Mailing Address - Phone:973-267-2293
Mailing Address - Fax:973-267-3144
Practice Address - Street 1:95 MOUNT KEMBLE AVE
Practice Address - Street 2:THEBAUD BUILDING, FOURTH FLOOR
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5155
Practice Address - Country:US
Practice Address - Phone:973-267-2293
Practice Address - Fax:973-267-3144
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO07041500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7104103Medicaid
NJS31575Medicare UPIN
NJ7104103Medicaid