MEDICARE: JOHN O'DONNELL III 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	RN326694	OH

General Provider Information

NPI Number	:	1598182131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN O'DONNELL III RN

Provider Business Mailing Address
First Line	:	1518 CRESTWOOD RD
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-3331
Country	:	US
Telephone Number	:	440-665-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 CRESTWOOD RD
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-3331
Country	:	US
Telephone Number	:	440-665-6440
Fax Number	:

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

Provider Enumeration Date	:	03/20/2014
Last Update Date	:	03/20/2014

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