Individual
DIANE M O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1220 DEWEY AVE, LORTON BUILDING, WAUWATOSA, WI 53213-2504
(414) 257-7356
(414) 257-7515
Mailing address
1220 DEWEY AVENUE, LORTON BUILDING, WAUWAUTOSA, WI 53213
(414) 257-7356
(414) 257-7515
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1020-033
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
74350
WI
367A00000X
Advanced Practice Midwife
74350
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100014190
—
WI
05
—
439-167-00
—
WI
Enumeration date
10/18/2006
Last updated
03/07/2023
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