Healthcare Provider Details

I. General information

NPI: 1770143901
Provider Name (Legal Business Name): MRS. ODESSHA RANA YORK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 14754
SAGINAW MI
48601-0754
US

IV. Provider business mailing address

PO BOX 14754
SAGINAW MI
48601-0754
US

V. Phone/Fax

Practice location:
  • Phone: 989-770-3570
  • Fax:
Mailing address:
  • Phone: 989-770-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704349299
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: