Provider Demographics
NPI:1942597828
Name:MCDONNELL, EILEEN MARIE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:MARIE
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:CRNP
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Other - First Name:
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-5864
Mailing Address - Fax:215-707-6867
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-5864
Practice Address - Fax:215-707-6867
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP011333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily