MEDICARE: SOPHIE ODHIAMBO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	914913	TX

General Provider Information

NPI Number	:	1568088805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE ODHIAMBO

Provider Business Mailing Address
First Line	:	1013 RIVERSTONE TRL
Second Line	:
City	:	PRINCETON
State	:	TX
Zip	:	75407-2260
Country	:	US
Telephone Number	:	469-579-1291
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 RIVERSTONE TRL
Second Line	:
City	:	PRINCETON
State	:	TX
Zip	:	75407-2260
Country	:	US
Telephone Number	:	469-579-1291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	06/23/2020

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Directions to “ SOPHIE ODHIAMBO ” Practice Location

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