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NPI Code Detail

MEDICARE: JACQUELINE ODHIAMBO CRNA

MEDICARE: JACQUELINE ODHIAMBO CRNA
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
1367500000XCertified Registered Nurse Anesthetist1101543TX
2367500000XCertified Registered Nurse Anesthetist0024196175VA

General Provider Information

NPI Number : 1912530288
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE ODHIAMBO CRNA
Provider Business Mailing Address
First Line : PO BOX 4439
Second Line :
City : HOUSTON
State : TX
Zip : 77210-4439
Country : US
Telephone Number : 713-792-2991
Fax Number :
Provider Business Practice Location Address
First Line : 2 BERNARDINE DR
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23602-4404
Country : US
Telephone Number : 757-886-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2020
Last Update Date : 03/26/2026

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