Healthcare Provider Details

I. General information

NPI: 1700456449
Provider Name (Legal Business Name): RUTH FLORENCE ODUOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

28 YORKSHIRE DRIVE EXT
TEWKSBURY MA
01876-2268
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-3900
  • Fax:
Mailing address:
  • Phone: 617-281-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2258864
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: