Individual
KEITH WAYNE ODENDAHL
Active
Individual
KEITH WAYNE ODENDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP03719
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1431940
—
LA
01
—
310063
WELLCARE
LA
01
—
P00712670
RAILROAD MCARE THRU PEPA
LA
Enumeration date
01/17/2006
Last updated
10/23/2024
Update your record
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