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General NPI Number Information
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NPI Number | 1164949954
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Entity Type | Individual
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Provider Name | LYNDA ODEN LARUE CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 150 GILBREATH DR STE 201
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City | ONEONTA
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State | AL
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Zip | 35121-2827
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Country | US
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Telephone | 205-274-8198
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Fax |
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Provider Business Mailing Address
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Address Line | 370 BULLARD RD
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City | BLOUNTSVILLE
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State | AL
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Zip | 35031-3651
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Country | US
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Telephone | 205-288-1913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1050053
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License Number State | AL
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