Provider Demographics
NPI:1063412542
Name:ODONNELL, EILEEN JOY (RN, APRN)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:JOY
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 IRONWORKS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1223
Mailing Address - Country:US
Mailing Address - Phone:860-664-0466
Mailing Address - Fax:860-669-3351
Practice Address - Street 1:345 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4738
Practice Address - Country:US
Practice Address - Phone:860-444-6711
Practice Address - Fax:860-437-0650
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000368363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400000368CT04OtherBLUE CROSS BLUE SHIELD
CT2V5541OtherHEALTH NET
CT368000OtherCONNECTICARE
S47007Medicare UPIN