Individual
MR. MARK G ODDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
17893 224TH ST, MANCHESTER, IA 52057-8629
(563) 927-6183
(563) 927-6183
Mailing address
PO BOX 359, MANCHESTER, IA 52057-0359
(563) 927-7457
(563) 927-7518
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D-074818
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1274647
—
IA
01
—
26702
RMC BC/BS IOWA
IA
05
—
327467
—
IA
01
—
35258
SUMNER BC/BS IOWA
IA
05
—
4274647
—
IA
01
—
43951
VINTON BC/BS IOWA
IA
01
—
47146
INDE BC/BS IOWA
IA
05
—
6274647
—
IA
Enumeration date
04/13/2006
Last updated
11/03/2015
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