Provider Demographics
NPI:1336637693
Name:O'DONNELL, ELAINE R (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:R
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:612 SEACOAST PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6627
Practice Address - Country:US
Practice Address - Phone:843-881-4440
Practice Address - Fax:843-352-2173
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant