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General NPI Number Information
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NPI Number | 1417550716
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Entity Type | Individual
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Provider Name | VALOSHA ASHLEIGH ODOM MBA
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Gender | Female
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 105 BRANTMERE CT
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City | JAMESTOWN
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State | NC
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Zip | 27282-8404
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Country | US
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Telephone | 336-554-3092
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1273
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City | JAMESTOWN
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State | NC
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Zip | 27282-1273
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Country | US
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Telephone | 773-828-9083
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Fax | 336-203-2213
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | N95779
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License Number State | NC
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