Provider Demographics
NPI:1831196120
Name:O'DELL, ANGELA LEA (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEA
Last Name:O'DELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEA
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:19 E SHAWNEE DR STE 2
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-7072
Practice Address - Country:US
Practice Address - Phone:618-684-2172
Practice Address - Fax:618-687-4480
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000354363L00000X
IL209.006868363LF0000X
FL9246868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200458610Medicaid
IN200458610Medicaid
INQ03915Medicare UPIN