Provider Demographics
NPI:1407074784
Name:O'DELL, ANGELA R (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:O'DELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2757
Mailing Address - Country:US
Mailing Address - Phone:864-388-0301
Mailing Address - Fax:864-388-0648
Practice Address - Street 1:113 LINER DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2311
Practice Address - Country:US
Practice Address - Phone:864-941-8170
Practice Address - Fax:864-388-1718
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily