Individual
COLLEEN ODONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2132 N 1700 W STE 230, LAYTON, UT 84041-7060
(801) 773-3900
(801) 773-3900
Mailing address
4017 N WOLF CREEK DR, EDEN, UT 84310-9894
(801) 690-6456
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
007859-1
NY
363AS0400X
Surgical Physician Assistant
Primary
6526009-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02108996
—
NY
Enumeration date
10/24/2005
Last updated
03/17/2018
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