Provider Demographics
NPI:1376522243
Name:ODONNELL, ANN E (DO)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:E
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52802-1812
Mailing Address - Country:US
Mailing Address - Phone:563-326-1661
Mailing Address - Fax:563-326-1901
Practice Address - Street 1:1820 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1812
Practice Address - Country:US
Practice Address - Phone:563-326-1661
Practice Address - Fax:563-326-1901
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5163295Medicaid
IA5163295Medicaid
IAG45648Medicare UPIN