Provider Demographics
NPI:1578150926
Name:O'DRISCOLL, PATRICIA ANN (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:O'DRISCOLL
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 1:28141 SWAN ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-2039
Mailing Address - Country:US
Mailing Address - Phone:586-924-2372
Mailing Address - Fax:
Practice Address - Street 1:28141 SWAN ISLAND DR
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-2039
Practice Address - Country:US
Practice Address - Phone:586-924-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704178173163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse