Provider Demographics
NPI:1033991138
Name:RODRIGUEZ IRIZARRY, ODALYS JANICE (AGNP)
Entity Type:Individual
Prefix:
First Name:ODALYS
Middle Name:JANICE
Last Name:RODRIGUEZ IRIZARRY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-4500
Mailing Address - Country:US
Mailing Address - Phone:919-575-8000
Mailing Address - Fax:
Practice Address - Street 1:3000 OLD 75 HWY
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1658
Practice Address - Country:US
Practice Address - Phone:919-575-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308039-01363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care