Healthcare Provider Details

I. General information

NPI: 1144949199
Provider Name (Legal Business Name): MINDFULNESS INTEGRATED HEALTHCARE ODIWO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 W LAKE MEAD BLVD STE 208
LAS VEGAS NV
89128-7648
US

IV. Provider business mailing address

1180 N TOWN CENTER DR STE 100
LAS VEGAS NV
89144-6308
US

V. Phone/Fax

Practice location:
  • Phone: 702-703-5262
  • Fax:
Mailing address:
  • Phone: 512-364-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDITH ODIWO
Title or Position: PROVIDER
Credential: APRN
Phone: 512-364-5830