Provider Demographics
NPI:1477036812
Name:ODONNELL, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
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 1:8675 TAMARISK RAVINE CT
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9386
Mailing Address - Country:US
Mailing Address - Phone:124-834-5250
Mailing Address - Fax:
Practice Address - Street 1:9795 VILLAGE PLACE BLVD
Practice Address - Street 2:SOLA STUDIO 15
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2087
Practice Address - Country:US
Practice Address - Phone:248-345-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist