Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1010544 | TX |
NPI | 1003429671 |
---|---|
Provider Name | Mrs. Edith Lamira Odiwo |
First Address | Keller, TX 76244-2098 |
Second Address | Keller, TX 76244-2098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2020 |
Last Update Date | 25/08/2020 |