Provider Demographics
NPI:1578880126
Name:ODGREN-COLE, JILL (ND)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:ODGREN-COLE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6039 EAST HOBART STREET
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:480-688-1899
Mailing Address - Fax:480-307-8685
Practice Address - Street 1:6039 EAST HOBART STREET
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-688-1899
Practice Address - Fax:480-307-8685
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath