Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 7115 | WI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 7115-33 | WI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 7115-33 | WI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 7115-33 | WI |
NPI | 1023562782 |
---|---|
Provider Name | Sara Elizabeth O'donnell |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53719-1208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2016 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7115-33 | WI DSPS LICENSURE (01) | WI |