MEDICARE: NYREE O'DONALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1750772364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYREE O'DONALD

Provider Business Mailing Address
First Line	:	674 LAKINS RD
Second Line	:
City	:	STETSON
State	:	ME
Zip	:	04488-3610
Country	:	US
Telephone Number	:	207-296-2204
Fax Number	:

Provider Business Practice Location Address
First Line	:	674 LAKINS RD
Second Line	:
City	:	STETSON
State	:	ME
Zip	:	04488-3610
Country	:	US
Telephone Number	:	207-296-2204
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. NYREE D. O'DONALD
Credential	:	RN
Telephone Number	:	207-296-2204

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	02/18/2015

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