Healthcare Provider Details

I. General information

NPI: 1497171334
Provider Name (Legal Business Name): LORETTA ODRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TILDEN STREET
BRONX NY
10467
US

IV. Provider business mailing address

801 TILDEN ST
BRONX NY
10467-6026
US

V. Phone/Fax

Practice location:
  • Phone: 646-756-0579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number318344
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021308
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number682136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: