MEDICARE: MS. SHARON LYNNE ODUM CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704147932	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164415949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON LYNNE ODUM CNP

Provider Business Mailing Address
First Line	:	2700 ROBERT T LONGWAY BLVD STE A
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-2190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 ROBERT T LONGWAY BLVD STE A
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-2190
Country	:	US
Telephone Number	:	810-659-5695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	02/10/2020

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