Healthcare Provider Details

I. General information

NPI: 1104780162
Provider Name (Legal Business Name): TAYLOR ODNEAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7349 S ALKIRE ST APT 306
LITTLETON CO
80127-3271
US

IV. Provider business mailing address

7349 S ALKIRE ST APT 306
LITTLETON CO
80127-3271
US

V. Phone/Fax

Practice location:
  • Phone: 208-340-7207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number1670579
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: