Provider Demographics
NPI:1790150621
Name:O'DELL, LYNSIE ANN (MSN, RN, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:LYNSIE
Middle Name:ANN
Last Name:O'DELL
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-2803
Mailing Address - Country:US
Mailing Address - Phone:937-667-7711
Mailing Address - Fax:
Practice Address - Street 1:915 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:937-498-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18455363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics