Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95008764 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | NP95008764 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95008764 | CA |
NPI | 1043708456 |
---|---|
Provider Name | Nicole O'donnell |
First Address | Carlsbad, CA 92009-8685 |
Second Address | Carlsbad, CA 92009-8685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2018 |
Last Update Date | 21/04/2021 |