Provider Demographics
NPI:1720707938
Name:ODELL, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ODELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 GRASSY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEIVASY
Mailing Address - State:WV
Mailing Address - Zip Code:26676-4101
Mailing Address - Country:US
Mailing Address - Phone:304-846-2085
Mailing Address - Fax:
Practice Address - Street 1:2477 GRASSY CREEK RD
Practice Address - Street 2:
Practice Address - City:LEIVASY
Practice Address - State:WV
Practice Address - Zip Code:26676-4101
Practice Address - Country:US
Practice Address - Phone:304-846-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker