Provider Demographics
NPI:1871175570
Name:ODOR, MONICA LYNNE (NP-C)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNNE
Last Name:ODOR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1138
Mailing Address - Country:US
Mailing Address - Phone:207-450-6157
Mailing Address - Fax:
Practice Address - Street 1:500 MARKET ST UNIT 1B
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3456
Practice Address - Country:US
Practice Address - Phone:603-294-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine