Provider Demographics
NPI:1003429671
Name:ODIWO, EDITH LAMIRA (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:LAMIRA
Last Name:ODIWO
Suffix:
Gender:F
Credentials:PMHNP-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9908 CROSWELL ST
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-2098
Mailing Address - Country:US
Mailing Address - Phone:512-364-5830
Mailing Address - Fax:
Practice Address - Street 1:2200 PASEO VERDE PKWY STE 190
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2703
Practice Address - Country:US
Practice Address - Phone:702-589-4871
Practice Address - Fax:702-589-4872
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1010544363LP0808X
NV838741363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health