MEDICARE: APRIL J ODOM NP

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	163W00000X	Registered Nurse	041369139	IL
2	363LF0000X	Family Nurse Practitioner	277000369	IL

General Provider Information

NPI Number	:	1467983486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL J ODOM NP

Provider Business Mailing Address
First Line	:	19740 GOVERNORS HWY STE 116
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2085
Country	:	US
Telephone Number	:	708-607-2503
Fax Number	:	778-200-3824

Provider Business Practice Location Address
First Line	:	19740 GOVERNORS HWY STE 116
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2085
Country	:	US
Telephone Number	:	708-607-2503
Fax Number	:	788-200-3824

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

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	05/26/2022

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