Provider Demographics
NPI:1922759570
Name:BURRELL-ODEYEMI, MARCIA ANGELLA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:ANGELLA
Last Name:BURRELL-ODEYEMI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:10539 SUGARBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5715
Mailing Address - Country:US
Mailing Address - Phone:301-412-5838
Mailing Address - Fax:
Practice Address - Street 1:10539 SUGARBERRY ST
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5715
Practice Address - Country:US
Practice Address - Phone:301-412-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR149910163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health