Healthcare Provider Details

I. General information

NPI: 1750979936
Provider Name (Legal Business Name): REBECCA A ODEDE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13331 W INDIAN SCHOOL RD STE B203
LITCHFIELD PARK AZ
85340-4340
US

IV. Provider business mailing address

13331 W INDIAN SCHOOL RD STE B203
LITCHFIELD PARK AZ
85340-4340
US

V. Phone/Fax

Practice location:
  • Phone: 623-269-3990
  • Fax: 623-269-3924
Mailing address:
  • Phone: 623-269-3990
  • Fax: 623-269-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number218880
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: