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General NPI Number Information
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NPI Number | 1215750609
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Entity Type | Individual
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Provider Name | EKOR WONAH ODAJI PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 12 PENNINGTON ST STE 100
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1026
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Country | US
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Telephone | 302-724-1181
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Fax |
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Provider Business Mailing Address
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Address Line | 590 RED MAPLE RD
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City | SMYRNA
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State | DE
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Zip | 19977-5294
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Country | US
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Telephone | 908-370-2902
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AN-0025824
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License Number State | DE
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