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General NPI Number Information
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NPI Number | 1497812200
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Entity Type | Individual
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Provider Name | GEORGIA ANN EVANS O'DONOGHUE LVN
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1120 S DORA ST
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City | UKIAH
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State | CA
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Zip | 95482-6340
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Country | US
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Telephone | 707-472-2722
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Fax | 707-472-2714
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Provider Business Mailing Address
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Address Line | 328 JONES ST
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City | UKIAH
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State | CA
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Zip | 95482-5412
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Country | US
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Telephone | 707-472-2700
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Fax | 707-472-2714
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN188450
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License Number State | CA
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