Provider Demographics
NPI:1205073004
Name:O'DONNELL, ERIN L (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LEA
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9900 BROADWAY EXT STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6323
Mailing Address - Country:US
Mailing Address - Phone:405-608-8833
Mailing Address - Fax:405-608-8818
Practice Address - Street 1:9900 BROADWAY EXT STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6323
Practice Address - Country:US
Practice Address - Phone:405-608-8833
Practice Address - Fax:405-608-8818
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK402560Medicare PIN