Individual
CORIANNE L O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
103 SKYLINE RD, BANGOR, ME 04401-2158
(610) 574-5628
Mailing address
103 SKYLINE RD, BANGOR, ME 04401-2158
(610) 574-5628
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1959
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019590
CONNECTICARE
—
01
—
P00336251
RAILROAD MEDICARE
—
Enumeration date
10/17/2005
Last updated
01/06/2011
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