Provider Demographics
NPI:1801255575
Name:ODONNELL, SHIVAUN (RN)
Entity type:Individual
Prefix:
First Name:SHIVAUN
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2409
Mailing Address - Country:US
Mailing Address - Phone:570-814-8229
Mailing Address - Fax:570-970-8553
Practice Address - Street 1:272 S RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2409
Practice Address - Country:US
Practice Address - Phone:570-814-8229
Practice Address - Fax:570-970-8553
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN660587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse