Provider Demographics
NPI:1073645107
Name:ODUM, PATRICIA M (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:ODUM
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:117 W BUNNY AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-739-3892
Mailing Address - Fax:805-614-5860
Practice Address - Street 1:1555 HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2917
Practice Address - Country:US
Practice Address - Phone:805-543-4043
Practice Address - Fax:805-543-4427
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA15381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15381OtherFNP LICENSE #