ODELL, LYNNE E (NP PSYCHIATRY)

Provider Demographics

• NPI: 1962499756
• Name: ODELL, LYNNE E (NP PSYCHIATRY)
• Entity Type: Individual
• Prefix: MS
• First Name: LYNNE
• Middle Name: E
• Last Name: ODELL
• Gender: F
• Credentials: NP PSYCHIATRY
• Other - Prefix: MRS
• Other - First Name: LYNNE
• Other - Middle Name: E
• Other - Last Name: ODELL-HOLZER
• Other - Last Name Type: Former Name
• Other - Credentials: NP PSYCHIATRY
• Mailing Address - Street 1: 133 CAMBRIDGE STREET
• Mailing Address - City: SYRACUSE
• Mailing Address - State: NY
• Mailing Address - Zip Code: 13210-2205
• Mailing Address - Country: US
• Mailing Address - Phone: 315-218-5963
• Mailing Address - Fax: 315-218-5963
• Practice Address - Street 1: 133 CAMBRIDGE STREET
• Practice Address - City: SYRACUSE
• Practice Address - State: NY
• Practice Address - Zip Code: 13210-2205
• Practice Address - Country: US
• Practice Address - Phone: 315-218-5963
• Practice Address - Fax: 315-218-5963
• Is Sole Proprietor?: Yes
• Enumeration Date: 2005-10-05
• Last Update Date: 2023-03-07

Provider Licenses

State	License ID	Taxonomies
NY	2547141	163W00000X
NY	332404	363LF0000X
NY	400498	363LP0808X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health
No	163W00000X	Nursing Service Providers	Registered Nurse
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	300298007	Other	VALUE OPTIONS PIN
	500021448	Other	MEDICARE RAILROAD
	00011447	Other	UBH PROV NUMBER
	094387546	Other	POMCO
	500021448	Other	MEDICARE RAILROAD ELDER MEDICAL
	F4004981	Other	NPP
NY	02218871	Medicaid
	155190	Other	VALUE OPTIONS
	CC2142	Other	MEDICARE
	BA0346	Other	MEDICARE NUMBER HOTZER ENTERPRISES
	11378483	Other	CAQH
	5825	Other	TOTAL CARE ID
	328380	Other	MENTAL HEALTH NETWORK
	6227587	Other	UN HEALTH CARE SERV PROVIDER NUMBER
NY	02218871	Other	MEDICAID ELDER MEDICAL
	2547141	Other	RN
	328380	Other	MANAGED HEALTH NETWORK
	500014206	Other	MEDICARE RAILROAD
	711721	Other	MVP
	F3324040	Other	FNP
	0809365	Other	CIGNA
	50001405	Other	MEDICARE RAILROAD CHHHC
	MH0407014	Other	DEA
	2547141	Other	RN
	50001405	Other	MEDICARE RAILROAD CHHHC
	500021448	Other	MEDICARE RAILROAD
	P14493	Medicare UPIN