MEDICARE: MS. ROBIN L ODEN 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5684	CO

General Provider Information

NPI Number	:	1508943150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBIN L ODEN NP

Provider Business Mailing Address
First Line	:	6021 SPURWOOD DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8147
Country	:	US
Telephone Number	:	719-574-6562
Fax Number	:	719-570-0386

Provider Business Practice Location Address
First Line	:	1115 ELKTON DR
Second Line	:	SUITE 403
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8507
Country	:	US
Telephone Number	:	719-574-6562
Fax Number	:	719-570-0386

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/15/2011

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