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General NPI Number Information
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NPI Number | 1629626684
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Entity Type | Individual
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Provider Name | ODOLINA CALDERON POPE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 954 W STATE ST
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City | SYCAMORE
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State | IL
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Zip | 60178-1335
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Country | US
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Telephone | 815-895-9144
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Fax |
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Provider Business Mailing Address
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Address Line | 504 CRYSTAL CT
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City | OSWEGO
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State | IL
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Zip | 60543-7937
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Country | US
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Telephone | 630-701-0767
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.019106
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License Number State | IL
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