Healthcare Provider Details

I. General information

NPI: 1245743640
Provider Name (Legal Business Name): BRIGID A O'DONNELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 S COTTONWOOD ST
MURRAY UT
84107
US

IV. Provider business mailing address

5171 S COTTONWOOD ST
MURRAY UT
84107-5704
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4266
  • Fax:
Mailing address:
  • Phone: 801-314-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: