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General NPI Number Information
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NPI Number | 1366959678
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Entity Type | Individual
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Provider Name | KRISTA M O'DONNELL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | NEW YORK SPINE AND BRAIN SURGERY DEPT OF NEUROSURGERY HSC T12 RM 080
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City | STONY BROOK
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State | NY
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Zip | 11794-8122
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Country | US
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Telephone | 631-444-1116
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Fax | 631-444-1535
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Provider Business Mailing Address
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Address Line | 40 BAYLOR DR
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City | SMITHTOWN
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State | NY
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Zip | 11787-2002
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Country | US
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Telephone | 631-786-4065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 613325
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 342183
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License Number State | NY
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