Provider Demographics
NPI:1497233720
Name:O'DELL, CHELSEA (LPN)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:O'DELL
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:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN DALE
Mailing Address - State:NY
Mailing Address - Zip Code:12763-0414
Mailing Address - Country:US
Mailing Address - Phone:845-699-5976
Mailing Address - Fax:
Practice Address - Street 1:3 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-2303
Practice Address - Country:US
Practice Address - Phone:845-647-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322032164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBT60126ZMedicaid