Provider Demographics
NPI:1487955563
Name:O'DRISCOLL, KIMBERLAIN CHENNAYE (LPN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLAIN
Middle Name:CHENNAYE
Last Name:O'DRISCOLL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SAINT ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3138
Mailing Address - Country:US
Mailing Address - Phone:718-742-2374
Mailing Address - Fax:718-993-9662
Practice Address - Street 1:760 E 160TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-7815
Practice Address - Country:US
Practice Address - Phone:718-742-2374
Practice Address - Fax:718-993-9662
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237364-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse