Provider Demographics
NPI:1295755320
Name:O'DONNELL, JACKIE RUTH (RN)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:RUTH
Last Name:O'DONNELL
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 1:1606 PHYSICIANS DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7361
Mailing Address - Country:US
Mailing Address - Phone:910-815-3994
Mailing Address - Fax:910-815-3998
Practice Address - Street 1:1606 PHYSICIANS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7361
Practice Address - Country:US
Practice Address - Phone:910-815-3994
Practice Address - Fax:910-815-3998
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN247313163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health