Provider Demographics
NPI:1588735872
Name:O'DONNELL, ALLISON MARIE (RD LDN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CLARENCE ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2328
Mailing Address - Country:US
Mailing Address - Phone:814-362-8717
Mailing Address - Fax:814-368-2085
Practice Address - Street 1:199 PLEASANT ST
Practice Address - Street 2:SUITE 32
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1098
Practice Address - Country:US
Practice Address - Phone:814-362-8717
Practice Address - Fax:814-368-2085
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered