Healthcare Provider Details

I. General information

NPI: 1457272429
Provider Name (Legal Business Name): INNOCENT UGOCHUKWU ODOH RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 HESSEN CASSEL RD # 4105
FORT WAYNE IN
46806-4579
US

IV. Provider business mailing address

4105 HESSEN CASSEL RD # 4105
FORT WAYNE IN
46806-4579
US

V. Phone/Fax

Practice location:
  • Phone: 260-246-8298
  • Fax:
Mailing address:
  • Phone: 260-246-8298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number28254300A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: