Provider Demographics
NPI:1649698978
Name:ODELL, ELLEN MARIE (DNP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:ODELL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 LANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5834
Mailing Address - Country:US
Mailing Address - Phone:479-841-7008
Mailing Address - Fax:
Practice Address - Street 1:4303 LANKFORD AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5834
Practice Address - Country:US
Practice Address - Phone:479-841-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS002268364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist