Provider Demographics
NPI:1649340506
Name:O'DONNELL, MAEVELYN ANDALIS (CRNA)
Entity type:Individual
Prefix:
First Name:MAEVELYN
Middle Name:ANDALIS
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MAEVELYN
Other - Middle Name:ARROYO
Other - Last Name:ANDALIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:650 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-4030
Mailing Address - Country:US
Mailing Address - Phone:337-378-5585
Mailing Address - Fax:
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442
Practice Address - Country:US
Practice Address - Phone:337-378-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3507367500000X
WA60198922163W00000X
CA538315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse