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General NPI Number Information
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NPI Number | 1073880621
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Entity Type | Individual
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Provider Name | MARIKO LEE ODHNER
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Gender | Female
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 269 UNION ST
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City | LYNN
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State | MA
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Zip | 01901-1314
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Country | US
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Telephone | 781-596-2502
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Fax | 781-596-3966
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Provider Business Mailing Address
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Address Line | 325 MAIN ST
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City | MEDFORD
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State | MA
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Zip | 02155-6152
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Country | US
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Telephone | 617-519-8246
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP37010
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2268187
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License Number State | MA
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