Healthcare Provider Details

I. General information

NPI: 1366472953
Provider Name (Legal Business Name): ODILE ANDERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ODILE ANDERSON CRNA

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 STATE HWY 161 STE 200
IRVING TX
75038-2241
US

IV. Provider business mailing address

6225 STATE HWY 161 STE 200
IRVING TX
75038-2241
US

V. Phone/Fax

Practice location:
  • Phone: 214-687-0001
  • Fax:
Mailing address:
  • Phone: 214-687-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number546249
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN642513
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: