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General NPI Number Information
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NPI Number | 1194965046
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Entity Type | Individual
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Provider Name | EVA ODELL
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Gender | Female
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 15 NW 20TH AVE
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City | BATTLE GROUND
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State | WA
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Zip | 98604-4226
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Country | US
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Telephone | 360-931-1656
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Fax |
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Provider Business Mailing Address
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Address Line | 7409 NE 144TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98682-5028
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Country | US
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Telephone | 360-931-1656
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | WA#MA0006933
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License Number State | WA
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