Healthcare Provider Details

I. General information

NPI: 1831196120
Provider Name (Legal Business Name): ANGELA LEA O'DELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA LEA MCLAUGHLIN NP

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E SHAWNEE DR STE 2
MURPHYSBORO IL
62966-7072
US

IV. Provider business mailing address

PO BOX 3988
CARBONDALE IL
62902-3988
US

V. Phone/Fax

Practice location:
  • Phone: 618-684-2172
  • Fax: 618-687-4480
Mailing address:
  • Phone: 618-457-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277000354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: