Provider Demographics
NPI:1497812200
Name:O'DONOGHUE, GEORGIA ANN EVANS (LVN)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:ANN EVANS
Last Name:O'DONOGHUE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 JONES ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5412
Mailing Address - Country:US
Mailing Address - Phone:707-472-2700
Mailing Address - Fax:707-472-2714
Practice Address - Street 1:1120 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6340
Practice Address - Country:US
Practice Address - Phone:707-472-2722
Practice Address - Fax:707-472-2714
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN188450164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse