Healthcare Provider Details

I. General information

NPI: 1992346092
Provider Name (Legal Business Name): ERIN KATHLEEN O'DONNELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 TOBIAS GADSON BLVD. SUITE 107
CHARLESTON SC
29407-4795
US

IV. Provider business mailing address

1065 NE 125TH STREET, #409
NORTH MIAMI FL
33161-5834
US

V. Phone/Fax

Practice location:
  • Phone: 843-745-5153
  • Fax: 843-766-8606
Mailing address:
  • Phone: 888-852-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number223466
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number23339
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: