Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 335960 | NY |
N | 363L00000X | Nurse Practitioner | F335960 | NY |
Y | 363LA2200X | Nurse Practitioner - Adult Health | F335960 | NY |
NPI | 1104054519 |
---|---|
Provider Name | Lynn A O'donnell |
First Address | Syracuse, NY 13210-1892 |
Second Address | Syracuse, NY 13210-1892 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 11/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03121299 | (05) | NY |
335960 | LICENSE (01) | NY |