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General NPI Number Information
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NPI Number | 1538635297
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Entity Type | Individual
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Provider Name | JENNIFER LEA NICOLE O'DONNELL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 13861 MANCHESTER ROAD
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63011
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Country | US
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Telephone | 636-556-0114
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Fax | 314-270-3694
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Provider Business Mailing Address
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Address Line | 13861 MANCHESTER ROAD
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63011
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Country | US
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Telephone | 636-556-0114
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Fax | 314-270-3694
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2010028309
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License Number State | MO
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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 | 2018040236
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License Number State | MO
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