Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 106690 | IA |
NPI | 1336564038 |
---|---|
Provider Name | Andrea Odvarko |
First Address | Davenport, IA 52807-7214 |
Second Address | Davenport, IA 52807-7209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2014 |
Last Update Date | 26/04/2021 |