Healthcare Provider Details

I. General information

NPI: 1811541147
Provider Name (Legal Business Name): GEORGIA ANNE ODELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14784 STATE HIGHWAY 30
DOWNSVILLE NY
13755
US

IV. Provider business mailing address

PO BOX J
DOWNSVILLE NY
13755-0912
US

V. Phone/Fax

Practice location:
  • Phone: 607-363-2120
  • Fax: 607-363-2105
Mailing address:
  • Phone: 607-363-2120
  • Fax: 607-363-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number619816-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: