Provider Demographics
NPI:1821037102
Name:ODELL, PAMELA MICHELLE (PAC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MICHELLE
Last Name:ODELL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1305 WEBSTER RD
Mailing Address - Street 2:SENECA HEALTH SERVICES INC
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651
Mailing Address - Country:US
Mailing Address - Phone:304-872-6796
Mailing Address - Fax:304-872-5415
Practice Address - Street 1:#1 STEVENS RD
Practice Address - Street 2:SENECA HEALTH SERVICES INC
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651
Practice Address - Country:US
Practice Address - Phone:304-872-2659
Practice Address - Fax:304-872-1685
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV01063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q39621Medicare UPIN