Healthcare Provider Details

I. General information

NPI: 1053290775
Provider Name (Legal Business Name): HALEY ODONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 8TH AVE W
CRESCO IA
52136-1062
US

IV. Provider business mailing address

235 8TH AVE W
CRESCO IA
52136-1062
US

V. Phone/Fax

Practice location:
  • Phone: 563-547-2101
  • Fax:
Mailing address:
  • Phone: 641-229-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberB188429
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163898
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: