Healthcare Provider Details

I. General information

NPI: 1922283530
Provider Name (Legal Business Name): JEANNINE ANN IGNACIO O'DONNELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-4114
  • Fax: 845-938-6541
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number521783-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: