Provider Demographics
NPI:1720820566
Name:ODLE, ERENDIRA BERNAL (APRN)
Entity type:Individual
Prefix:
First Name:ERENDIRA
Middle Name:BERNAL
Last Name:ODLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10244 NICKLAUS ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7666
Mailing Address - Country:US
Mailing Address - Phone:219-973-1400
Mailing Address - Fax:
Practice Address - Street 1:10012 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4055
Practice Address - Country:US
Practice Address - Phone:219-227-5119
Practice Address - Fax:219-227-5190
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF03240871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner