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Individual

MS. LYNNE E. ODELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP PSYCHIATRY

Contact information

Practice address
133 CAMBRIDGE STREET, SYRACUSE, NY 13210-2205
(315) 218-5963
(315) 218-5963
Mailing address
133 CAMBRIDGE STREET, SYRACUSE, NY 13210-2205
(315) 218-5963
(315) 218-5963

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2547141
NY
363LF0000X
Family Nurse Practitioner
332404
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
400498
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00011447
UBH PROV NUMBER
01
02218871
MEDICAID ELDER MEDICAL
NY
05
02218871
NY
01
0809365
CIGNA
01
094387546
POMCO
01
11378483
CAQH
01
155190
VALUE OPTIONS
01
2547141
RN
01
300298007
VALUE OPTIONS PIN
01
328380
MENTAL HEALTH NETWORK
01
50001405
MEDICARE RAILROAD CHHHC
01
500014206
MEDICARE RAILROAD
01
500021448
MEDICARE RAILROAD
01
5825
TOTAL CARE ID
01
6227587
UN HEALTH CARE SERV PROVIDER NUMBER
01
711721
MVP
01
BA0346
MEDICARE NUMBER HOTZER ENTERPRISES
01
CC2142
MEDICARE
01
F3324040
FNP
01
F4004981
NPP
Enumeration date
10/05/2005
Last updated
03/07/2023
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