Provider Demographics
NPI:1285268417
Name:ODON, STEPHEN M (DNP, APRNC-AG)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:ODON
Suffix:
Gender:M
Credentials:DNP, APRNC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 E HURON ST FL 9
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-926-2441
Mailing Address - Fax:312-926-9624
Practice Address - Street 1:201 E HURON ST FL 9
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3197
Practice Address - Country:US
Practice Address - Phone:312-926-2441
Practice Address - Fax:312-926-9624
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020928363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner