Healthcare Provider Details

I. General information

NPI: 1225382377
Provider Name (Legal Business Name): JOELLE ELIZABETH ODDEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JOELLE ELIZABETH CRESSMAN

II. Dates (important events)

Enumeration Date: 10/27/2012
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE M/S B-5506
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

2525 CHICAGO AVE M/S B-5506
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6000
  • Fax:
Mailing address:
  • Phone: 612-813-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN60108879
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAP60320778
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP 4234
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-180541-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: