Basic Information
| Provider Information | |||||||||
| NPI: | 1992346092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'DONNELL | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1065 NE 125TH STREET, #409 | ||||||||
| Address2: | |||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331615834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888526672 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1483 TOBIAS GADSON BLVD. | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294074795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437455153 | ||||||||
| FaxNumber: | 8437668606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2019 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 223466 | SC | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 23339 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.