Provider Demographics
NPI:1790845691
Name:BONDIETTI-ODELL, KATHY L (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:L
Last Name:BONDIETTI-ODELL
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 1:27970 N 61ST PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-8740
Mailing Address - Country:US
Mailing Address - Phone:480-575-2902
Mailing Address - Fax:480-502-2364
Practice Address - Street 1:33606 N 60TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-5243
Practice Address - Country:US
Practice Address - Phone:480-575-2000
Practice Address - Fax:480-488-7055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN049065163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ593344OtherAHCCCS