Provider Demographics
NPI:1104044387
Name:ODENBAUGH, TAMMY (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:ODENBAUGH
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 1:1035 HARRISON DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3827
Mailing Address - Country:US
Mailing Address - Phone:240-568-0407
Mailing Address - Fax:
Practice Address - Street 1:600 PATRIOT LN
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1351
Practice Address - Country:US
Practice Address - Phone:410-969-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP29581164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse