Provider Demographics
NPI:1164891446
Name:O'DAY, ERIN (CPM LM)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:O'DAY
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:GENESEE DEPOT
Mailing Address - State:WI
Mailing Address - Zip Code:53127-0365
Mailing Address - Country:US
Mailing Address - Phone:262-352-4852
Mailing Address - Fax:
Practice Address - Street 1:S43W31131 STATE RTE 83
Practice Address - Street 2:
Practice Address - City:GENESEE DEPOT
Practice Address - State:WI
Practice Address - Zip Code:53127-0365
Practice Address - Country:US
Practice Address - Phone:262-352-4852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI105-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife