Provider Demographics
NPI:1154079861
Name:ODEN, SHE'MAINE F (BSW)
Entity Type:Individual
Prefix:
First Name:SHE'MAINE
Middle Name:F
Last Name:ODEN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 E THAYER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-5014
Mailing Address - Country:US
Mailing Address - Phone:701-595-5181
Mailing Address - Fax:701-595-5181
Practice Address - Street 1:2403 E THAYER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-5014
Practice Address - Country:US
Practice Address - Phone:701-595-5181
Practice Address - Fax:701-595-5181
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator