Provider Demographics
NPI:1033186929
Name:ODELL, BETTY (NP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:ODELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 145 NE ONCOLOGY
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2982
Mailing Address - Country:US
Mailing Address - Phone:704-783-1370
Mailing Address - Fax:704-783-1389
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:SUITE 145 NE ONCOLOGY
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-783-1370
Practice Address - Fax:704-783-1389
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC299028BOtherMEDICARE PTAN
NCS91212Medicare UPIN