Provider Demographics
NPI:1699179374
Name:ODEN, LYNETTE (TECHNOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:
Last Name:ODEN
Suffix:
Gender:F
Credentials:TECHNOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18258 EXCHANGE AVE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2982
Mailing Address - Country:US
Mailing Address - Phone:708-208-5584
Mailing Address - Fax:708-858-8971
Practice Address - Street 1:18258 EXCHANGE AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2982
Practice Address - Country:US
Practice Address - Phone:708-208-5584
Practice Address - Fax:708-858-8971
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246QH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QH0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHematology