Provider Demographics
NPI:1437510070
Name:O'DONNELL, HEATHER E (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-3544
Mailing Address - Country:US
Mailing Address - Phone:608-359-5792
Mailing Address - Fax:
Practice Address - Street 1:1321 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3544
Practice Address - Country:US
Practice Address - Phone:608-359-5792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI224467163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse