Individual
NICOLE ANN ODLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4011 GATEWAY BLVD, MEDICAL OFFICE BUILDING 3 SUITE 3000, NEWBURGH, IN 47630
(812) 858-9400
Mailing address
4011 GATEWAY BLVD, MEDICAL OFFICE BUILDING 3 SUITE 3000, NEWBURGH, IN 47630
(812) 858-9400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11021918A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02007176A
STATE MEDICAL LICENSE
IN
Enumeration date
06/21/2021
Last updated
09/26/2024
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