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General NPI Number Information
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NPI Number | 1730814260
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Entity Type | Individual
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Provider Name | HEIDI LISA ODUM APRN
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Gender | Female
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 224 PLEASANT STREET, SUITE G300
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City | CONCORD
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State | NH
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Zip | 03301
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Country | US
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Telephone | 603-224-9995
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Fax | 603-226-0859
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Provider Business Mailing Address
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Address Line | 248 PLEASANT ST STE G300
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City | CONCORD
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State | NH
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Zip | 03301-7530
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Country | US
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Telephone | 603-224-9995
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Fax | 603-226-0859
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 064437-23
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 064437-23
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License Number State | NH
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