Provider Demographics
NPI:1356687503
Name:O'DONNELL, CYNTHIA (CPM, CNM, RN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:CPM, CNM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CATES RD
Mailing Address - Street 2:
Mailing Address - City:PARKMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04443-3341
Mailing Address - Country:US
Mailing Address - Phone:207-277-3283
Mailing Address - Fax:
Practice Address - Street 1:126 CATES RD
Practice Address - Street 2:
Practice Address - City:PARKMAN
Practice Address - State:ME
Practice Address - Zip Code:04443-3341
Practice Address - Country:US
Practice Address - Phone:207-277-3283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER033452163WW0101X
TN12080030176B00000X
ME112013367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No176B00000XOther Service ProvidersMidwife