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Individual
MRS. STACI S O'DELL
Active
Individual
MRS. STACI S O'DELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
131460-030
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3433-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0058230
—
IA
Enumeration date
02/14/2006
Last updated
12/13/2011
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