Healthcare Provider Details

I. General information

NPI: 1144303587
Provider Name (Legal Business Name): JANE O'DONNELL PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

4511 HARLEM RD SUITE 202
AMHERST NY
14226-3803
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7561
  • Fax: 716-888-3801
Mailing address:
  • Phone: 716-839-6720
  • Fax: 716-839-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number253734
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF380436
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: