Provider Demographics
NPI:1811541147
Name:ODELL, GEORGIA ANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:ANNE
Last Name:ODELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX J
Mailing Address - Street 2:
Mailing Address - City:DOWNSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13755-0912
Mailing Address - Country:US
Mailing Address - Phone:607-363-2120
Mailing Address - Fax:607-363-2105
Practice Address - Street 1:14784 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:DOWNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13755
Practice Address - Country:US
Practice Address - Phone:607-363-2120
Practice Address - Fax:607-363-2105
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY619816-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNONEOtherNONE