Provider Demographics
NPI:1467602078
Name:ODIHIRIN, ADESUA VIVIAN
Entity Type:Individual
Prefix:MRS
First Name:ADESUA
Middle Name:VIVIAN
Last Name:ODIHIRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W MOSHOLU PKWY S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1150
Mailing Address - Country:US
Mailing Address - Phone:347-968-6367
Mailing Address - Fax:
Practice Address - Street 1:40 W MOSHOLU PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1150
Practice Address - Country:US
Practice Address - Phone:347-968-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY573093-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse