Individual
MR. PHILLIP RAY ODLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, RN-BC
Contact information
Practice address
3007 EDGEWOOD PARK, MARION, IL 62959-5513
(618) 889-0031
Mailing address
3007 EDGEWOOD PARK, MARION, IL 62959-5513
(618) 889-0031
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041.401540
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.401540
REGISTERED NURSE LICENSE
IL
01
—
2011010604
AMERICAN NURSES CREDENTIALING CENTER - NURSING INFORMATICS BOARD CERTIFICATION
MD
Enumeration date
05/27/2022
Last updated
05/27/2022
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