Provider Demographics
NPI:1801349808
Name:ODONNELL, ANN (LPN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 NETHERLAND AVE
Mailing Address - Street 2:APT 2A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1780
Mailing Address - Country:US
Mailing Address - Phone:718-300-9694
Mailing Address - Fax:
Practice Address - Street 1:5644 NETHERLAND AVE
Practice Address - Street 2:APT 2A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1780
Practice Address - Country:US
Practice Address - Phone:718-300-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2711135-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY164W00000XMedicaid