Provider Demographics
NPI:1760116198
Name:ODELL, ABBY (LPN)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:ODELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16317-1830
Mailing Address - Country:US
Mailing Address - Phone:814-758-9534
Mailing Address - Fax:
Practice Address - Street 1:184 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:16317-1830
Practice Address - Country:US
Practice Address - Phone:814-758-9534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN315453164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse