Healthcare Provider Details

I. General information

NPI: 1255307013
Provider Name (Legal Business Name): ROBIN LEE O'DELL ARNP/CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 REID ST., ATTN: MCHJ-QCR
TACOMA WA
98431-0001
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040 REID ST., ATTN: MCHJ-QCR
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2252
  • Fax: 253-968-3278
Mailing address:
  • Phone: 253-968-2252
  • Fax: 253-968-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP30005371
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: