Provider Demographics
NPI:1710754825
Name:ODELL, JENNA MARIE (MSN, AGACNP-BC, CCRN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:ODELL
Suffix:
Gender:F
Credentials:MSN, AGACNP-BC, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38448 ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-1053
Mailing Address - Country:US
Mailing Address - Phone:440-935-6986
Mailing Address - Fax:
Practice Address - Street 1:38448 ARBOR CT
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044-1053
Practice Address - Country:US
Practice Address - Phone:440-935-6986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2023151843363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care