Provider Demographics
NPI:1861531907
Name:ODONNELL, LARAINE (RN)
Entity type:Individual
Prefix:MRS
First Name:LARAINE
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LARAINE
Other - Middle Name:
Other - Last Name:MCELHANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3345 CORNER RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:43001-8708
Mailing Address - Country:US
Mailing Address - Phone:740-587-4645
Mailing Address - Fax:
Practice Address - Street 1:8163 KINGFISHER LANE
Practice Address - Street 2:
Practice Address - City:PINKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147
Practice Address - Country:US
Practice Address - Phone:614-833-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN318895163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2687507Medicaid