Provider Demographics
NPI:1720405228
Name:ODELUGA, IRENE (MS RN FNP - BC)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:ODELUGA
Suffix:
Gender:F
Credentials:MS RN FNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3308
Mailing Address - Country:US
Mailing Address - Phone:219-397-6000
Mailing Address - Fax:219-397-6358
Practice Address - Street 1:915 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3308
Practice Address - Country:US
Practice Address - Phone:219-397-6000
Practice Address - Fax:219-397-6358
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71004855A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71004855AOtherLICENSE