Provider Demographics
NPI:1659807253
Name:O'DONNELL, BRYNN NICOLE (APN)
Entity Type:Individual
Prefix:
First Name:BRYNN
Middle Name:NICOLE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:BRYNN
Other - Middle Name:NICOLE
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 E BRUSH HILL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5661
Mailing Address - Country:US
Mailing Address - Phone:331-231-6200
Mailing Address - Fax:331-231-6201
Practice Address - Street 1:133 E BRUSH HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5661
Practice Address - Country:US
Practice Address - Phone:331-231-6200
Practice Address - Fax:331-231-6201
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015901363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner