Provider Demographics
NPI:1487809802
Name:O'DRISCOLL, ILONA
Entity type:Individual
Prefix:MRS
First Name:ILONA
Middle Name:
Last Name:O'DRISCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 S BAAS DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53146-5504
Mailing Address - Country:US
Mailing Address - Phone:262-679-4846
Mailing Address - Fax:
Practice Address - Street 1:6275 SO. BAAS DR.
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53146-5504
Practice Address - Country:US
Practice Address - Phone:262-679-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI120057-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health