Healthcare Provider Details

I. General information

NPI: 1659221166
Provider Name (Legal Business Name): ISABELLA FAITH O'DONNELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FELLOWS ST
SCRANTON PA
18504-2222
US

IV. Provider business mailing address

2417 LANTERN LN
MACUNGIE PA
18062-9094
US

V. Phone/Fax

Practice location:
  • Phone: 570-591-5280
  • Fax: 570-230-0013
Mailing address:
  • Phone: 484-716-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067515
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: