1790150621 NPI number — MRS. LYNSIE ANN O'DELL MSN, RN, CPNP-PC

Table of content: MRS. LYNSIE ANN O'DELL MSN, RN, CPNP-PC (NPI 1790150621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790150621 NPI number — MRS. LYNSIE ANN O'DELL MSN, RN, CPNP-PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'DELL
Provider First Name:
LYNSIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, CPNP-PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790150621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 933432
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-641-5072
Provider Business Mailing Address Fax Number:
937-641-6129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 MICHIGAN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIDNEY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45365-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-498-4880
Provider Business Practice Location Address Fax Number:
937-494-5295
Provider Enumeration Date:
12/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  APRN.CNP.18455 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0266646 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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