| NPI | 1972973634 |
|---|---|
| Former Name | KATIE NICOLE O'DONNELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00379700) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA057891) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2016-01-05 |