Healthcare Provider Details

I. General information

NPI: 1891101168
Provider Name (Legal Business Name): PATIENCE ODINA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7668B STANDISH PL SUITE #18
ROCKVILLE MD
20855-2701
US

IV. Provider business mailing address

7668B STANDISH PL STE 18
ROCKVILLE MD
20855-2701
US

V. Phone/Fax

Practice location:
  • Phone: 301-920-7060
  • Fax: 240-366-5952
Mailing address:
  • Phone: 301-920-7060
  • Fax: 240-366-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR174233
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: