Individual
MS. STEPHANIE M. O'DELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10625 W NORTH AVE STE 102, MILWAUKEE, WI 53226-2315
(414) 877-5350
(414) 877-5360
Mailing address
10625 W NORTH AVE STE 102, MILWAUKEE, WI 53226-2315
(414) 877-5350
(414) 877-5360
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
131693
WI
363LF0000X
Family Nurse Practitioner
Primary
3315-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
331503300004
BLUE SHIELD
WI
01
—
331503333334
BLUE SHIELD
WI
05
—
36052500
—
WI
Enumeration date
11/12/2007
Last updated
07/21/2022
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