Individual
NICOLE ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4870
(215) 955-6000
Mailing address
5853 TRESTLE WAY, KNOXVILLE, TN 37918-7083
(801) 502-8194
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN787676
PA
Other
Enumeration date
06/24/2024
Last updated
06/24/2024
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