Provider Demographics
NPI:1194263020
Name:ODELL, ALICE (DNP, MPH, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:ODELL
Suffix:
Gender:F
Credentials:DNP, MPH, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 E 149TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5603
Mailing Address - Country:US
Mailing Address - Phone:646-634-1517
Mailing Address - Fax:718-665-6420
Practice Address - Street 1:349 E 149TH ST FL 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5603
Practice Address - Country:US
Practice Address - Phone:914-774-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659458-1163WP0200X
NY342663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics