Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | 207W00000X | AZ |
NPI | 1821453689 |
---|---|
Provider Name | Mrs. Renee Odell |
First Address | Phoenix, AZ 85020-5505 |
Second Address | Phoenix, AZ 85020-5505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2015 |
Last Update Date | 22/12/2015 |