Provider Demographics
NPI:1598182131
Name:O'DONNELL, JOHN III (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:O'DONNELL
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3331
Mailing Address - Country:US
Mailing Address - Phone:440-665-6440
Mailing Address - Fax:
Practice Address - Street 1:1518 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3331
Practice Address - Country:US
Practice Address - Phone:440-665-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN326694163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse