Provider Demographics
NPI:1477885846
Name:ODEN, PATRICIA LOUISA (LPN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LOUISA
Last Name:ODEN
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 1:3021 BRIDGEPORT WAY W APT D
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4628
Mailing Address - Country:US
Mailing Address - Phone:253-906-3573
Mailing Address - Fax:
Practice Address - Street 1:3021 BRIDGEPORT WAY W APT D
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4628
Practice Address - Country:US
Practice Address - Phone:253-906-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00056067164W00000X
WARC00052304171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator