Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | M-7399 | ID |
NPI | 1013946391 |
---|---|
Provider Name | Dr. Janat E. O'donnell |
First Address | Meridian, ID 83642-1026 |
Second Address | Boise, ID 83706-1300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 01/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010004463 | BLUE SHIELD (01) | ID |
1138439 | CIGNA MEDICARE (01) | ID |
290010172 | RR MEDICARE (01) | ID |
45872 | BLUE CROSS (01) | ID |
805025300 | (05) | ID |
F66572 | (02) | ID |