Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | NP-01140 | OH |
NPI | 1073606091 |
---|---|
Provider Name | Ms. Peggy Ann O'donnell |
First Address | Lyndhurst, OH 44124-1261 |
Second Address | Cleveland, OH 44106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2433870 | (05) | OH |