Provider Demographics
NPI:1508943150
Name:ODEN, ROBIN L (NP)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:L
Last Name:ODEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:6021 SPURWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8147
Mailing Address - Country:US
Mailing Address - Phone:719-574-6562
Mailing Address - Fax:719-570-0386
Practice Address - Street 1:1115 ELKTON DR
Practice Address - Street 2:SUITE 403
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8507
Practice Address - Country:US
Practice Address - Phone:719-574-6562
Practice Address - Fax:719-570-0386
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO5684363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA103295Medicare UPIN