Provider Demographics
NPI:1629626684
Name:POPE, ODOLINA CALDERON (FNP-C)
Entity Type:Individual
Prefix:
First Name:ODOLINA
Middle Name:CALDERON
Last Name:POPE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CRYSTAL CT
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7937
Mailing Address - Country:US
Mailing Address - Phone:630-701-0767
Mailing Address - Fax:
Practice Address - Street 1:954 W STATE ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1335
Practice Address - Country:US
Practice Address - Phone:815-895-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019106363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner