MEDICARE: MISS LISA MARIE O'DONNELL RN

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	163W00000X	Registered Nurse	RN618269	PA

General Provider Information

NPI Number	:	1508113028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LISA MARIE O'DONNELL RN

Provider Business Mailing Address
First Line	:	201 SUNNYBROOK RD
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-3241
Country	:	US
Telephone Number	:	484-995-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SUNNYBROOK RD
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-3241
Country	:	US
Telephone Number	:	484-995-7707
Fax Number	:

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

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/15/2012

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