Provider Demographics
NPI:1538663687
Name:O'DONNELL, MAUREEN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
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 1013
Mailing Address - Street 2:540 MAPLE LANE
Mailing Address - City:SOUTHHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971
Mailing Address - Country:US
Mailing Address - Phone:631-765-2437
Mailing Address - Fax:
Practice Address - Street 1:540 MAPLE LANE
Practice Address - Street 2:
Practice Address - City:SOUTHHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971
Practice Address - Country:US
Practice Address - Phone:631-765-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341130-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse