Individual
MRS. CRYSTAL NOEL ODEGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1079 S ANCONA AVE STE 100, EAGLE, ID 83616-7443
(208) 853-2273
Mailing address
1652 W SUNNY SLOPE DR, MERIDIAN, ID 83642-4336
(541) 285-4851
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1982
ID
Other
Enumeration date
04/07/2021
Last updated
04/07/2021
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