Provider Demographics
NPI:1457094260
Name:O'DONNELL, ALYSSA KANE (RN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KANE
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:ACCORD
Mailing Address - State:NY
Mailing Address - Zip Code:12404-0009
Mailing Address - Country:US
Mailing Address - Phone:845-687-2400
Mailing Address - Fax:845-687-7109
Practice Address - Street 1:122 KYSERIKE RD
Practice Address - Street 2:
Practice Address - City:ACCORD
Practice Address - State:NY
Practice Address - Zip Code:12404-5533
Practice Address - Country:US
Practice Address - Phone:845-687-2400
Practice Address - Fax:845-687-7109
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704629163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool