Provider Demographics
NPI:1689898751
Name:O'DELL, TONYA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:ANN
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 1:3307 SANDBAK AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8514
Mailing Address - Country:US
Mailing Address - Phone:307-250-1164
Mailing Address - Fax:
Practice Address - Street 1:3307 SANDBAK AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8514
Practice Address - Country:US
Practice Address - Phone:307-250-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse