Individual
MRS. CARLY M ODESINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
270 MAIN ST, PORTLAND, CT 06480-1836
(860) 342-3392
(860) 358-8658
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4820
(860) 358-8661
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
12.006642
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008067661
—
CT
Enumeration date
06/16/2016
Last updated
09/14/2018
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