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General NPI Number Information
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NPI Number | 1396376729
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Entity Type | Individual
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Provider Name | ODETTE NTAM NP
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Gender | Female
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 3800 RESERVOIR RD NW
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City | WASHINGTON
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State | DC
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Zip | 20007-2113
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Country | US
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Telephone | 202-444-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 3714 FORT LINCOLN DR NE
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City | WASHINGTON
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State | DC
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Zip | 20018-4303
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Country | US
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Telephone |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN1009092
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 364ST0500X
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Taxonomy Name | Transplantation Clinical Nurse Specialist
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License Number | RN1009092
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN1009092
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License Number State | DC
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