1861531907 NPI number — MRS. LARAINE ODONNELL RN

Table of content: MRS. LARAINE ODONNELL RN (NPI 1861531907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861531907 NPI number — MRS. LARAINE ODONNELL RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODONNELL
Provider First Name:
LARAINE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCELHANEY
Provider Other First Name:
LARAINE
Provider Other Middle Name:
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:
1861531907
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:
3345 CORNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43001-8708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-587-4645
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8163 KINGFISHER LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINKERINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-833-1731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2007

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: 163WH0200X , with the licence number:  RN318895 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2687507 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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