Provider Demographics
NPI:1437630118
Name:ODONNELL, MELISSA
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WV
Mailing Address - Zip Code:26033-1217
Mailing Address - Country:US
Mailing Address - Phone:304-686-3305
Mailing Address - Fax:
Practice Address - Street 1:12 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:WV
Practice Address - Zip Code:26033-1217
Practice Address - Country:US
Practice Address - Phone:304-686-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV77022163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool