Provider Demographics
NPI:1467924431
Name:O'DELL, ELLEN M (RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:O'DELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PORTSMOUTH CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3442
Mailing Address - Country:US
Mailing Address - Phone:843-817-6949
Mailing Address - Fax:
Practice Address - Street 1:4050 BRIDGE VIEW DR STE 600
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8415
Practice Address - Country:US
Practice Address - Phone:843-953-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225450163WS0200X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool