Provider Demographics
NPI:1720024714
Name:O'DONNELL, JEANIE COLBERT (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:JEANIE
Middle Name:COLBERT
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2553 VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2439
Mailing Address - Country:US
Mailing Address - Phone:801-583-0842
Mailing Address - Fax:801-584-1298
Practice Address - Street 1:500 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:801-584-1298
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT190548-4405363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology