1548342652 NPI number — MS. NANCY B ODONNELL OTRL BC AC SF

Table of content: MS. NANCY B ODONNELL OTRL BC AC SF (NPI 1548342652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548342652 NPI number — MS. NANCY B ODONNELL OTRL BC AC SF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODONNELL
Provider First Name:
NANCY
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL BC AC SF
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRUDER
Provider Other First Name:
NANCY
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548342652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 S BROOK FOREST ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-788-4546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
712 N MONROE
Provider Second Line Business Practice Location Address:
SEDWICK HEALTH CARE CENTER
Provider Business Practice Location Address City Name:
SEDGWICK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-772-5185
Provider Business Practice Location Address Fax Number:
316-772-0396
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1700244 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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