MEDICARE: MRS. ILONA O'DRISCOLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	120057-030	WI

General Provider Information

NPI Number	:	1487809802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ILONA O'DRISCOLL

Provider Business Mailing Address
First Line	:	6275 S BAAS DR
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53146-5504
Country	:	US
Telephone Number	:	262-679-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	6275 SO. BAAS DR.
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53146-5504
Country	:	US
Telephone Number	:	262-679-4846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	11/26/2008

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