Provider Demographics
NPI:1477830974
Name:O'DONNELL, MICHELLE CAROLINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CAROLINE
Last Name:O'DONNELL
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Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO 2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-791-5200
Mailing Address - Fax:513-791-5229
Practice Address - Street 1:4460 RED BANK RD
Practice Address - Street 2:SU. 110
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2172
Practice Address - Country:US
Practice Address - Phone:513-791-5200
Practice Address - Fax:513-791-5229
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2019-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50.003422363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant