Provider Demographics
NPI:1346916061
Name:ODONNELL, SAMANTHA (CRNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 QUAY RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1911
Mailing Address - Country:US
Mailing Address - Phone:267-471-0431
Mailing Address - Fax:
Practice Address - Street 1:33 S DELAWARE AVE STE 204A
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1524
Practice Address - Country:US
Practice Address - Phone:610-480-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP042001363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health