Healthcare Provider Details

I. General information

NPI: 1194263020
Provider Name (Legal Business Name): ALICE ODELL DNP, MPH, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2017
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 E 149TH ST FL 3
BRONX NY
10451-5603
US

IV. Provider business mailing address

349 E 149TH ST FL 3
BRONX NY
10451-5603
US

V. Phone/Fax

Practice location:
  • Phone: 914-774-5861
  • Fax:
Mailing address:
  • Phone: 646-634-1517
  • Fax: 718-665-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number659458-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342663
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: