Provider Demographics
NPI:1124557491
Name:ODERA, ELIZABETH AWINO (LPN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AWINO
Last Name:ODERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 GREYSTONE LN APT 4
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4919
Mailing Address - Country:US
Mailing Address - Phone:585-489-3209
Mailing Address - Fax:
Practice Address - Street 1:132 GREYSTONE LANE
Practice Address - Street 2:APT. 4
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4919
Practice Address - Country:US
Practice Address - Phone:585-489-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323024164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse