Basic Information
| Provider Information | |||||||||
| NPI: | 1730330671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ODONNELL | ||||||||
| FirstName: | ALAINA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15223 N 87TH ST | ||||||||
| Address2: | #110 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852602639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806824100 | ||||||||
| FaxNumber: | 4806824101 | ||||||||
| Practice Location | |||||||||
| Address1: | 15223 N 87TH ST | ||||||||
| Address2: | #110 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852602639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806824100 | ||||||||
| FaxNumber: | 4806824101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2008 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 4267 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | 4267 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.