Active NPI
Elisha Odell
- Licensed Practical Nurse
- Cottage Grove, OR
National Provider Identifier
1932597093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 200930509LPN
- Practice address
- 1345 Birch Ave
Cottage Grove, OR 97424-1416 - Phone
- (541) 942-3939
- Fax
- (541) 942-9310
- NPI assigned
- Dec 24, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 200930509LPN | OR | Primary |
Addresses
Primary practice location
1345 Birch Ave
Cottage Grove, OR 97424-1416
Mailing address
1345 Birch Ave
Cottage Grove, OR 97424-1416
Phone (541) 942-3939
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019047 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200930509LPN | OR | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419379200000",
"number": "1932597093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1345 BIRCH AVE",
"city": "COTTAGE GROVE",
"state": "OR",
"postal_code": "974241416",
"telephone_number": "541-942-3939",
"fax_number": "541-942-9310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1345 BIRCH AVE",
"city": "COTTAGE GROVE",
"state": "OR",
"postal_code": "974241416",
"telephone_number": "541-942-3939",
"fax_number": "541-942-9310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODELL",
"first_name": "ELISHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-24",
"last_updated": "2014-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OR",
"license": "200930509LPN",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019047",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cottage Grove, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.