Healthcare Provider Details

I. General information

NPI: 1710450317
Provider Name (Legal Business Name): MADELINE S CORSON-O'DONNELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADELINE S CORSON-O'DONNELL CRNP

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 LEONARD AVE STE 200
WASHINGTON PA
15301-3368
US

IV. Provider business mailing address

95 LEONARD AVE STE 200
WASHINGTON PA
15301-3368
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-3100
  • Fax:
Mailing address:
  • Phone: 724-223-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019455
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: