Provider Demographics
NPI:1952656175
Name:O'DONNELL, CHARLES JR (MSN, CRNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:O'DONNELL
Suffix:JR
Gender:M
Credentials:MSN, CRNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 STATE RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4609
Mailing Address - Country:US
Mailing Address - Phone:610-626-8085
Mailing Address - Fax:610-626-8032
Practice Address - Street 1:5060 STATE RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4609
Practice Address - Country:US
Practice Address - Phone:610-626-8085
Practice Address - Fax:610-626-8032
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP012172363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health