Provider Demographics
NPI:1578025805
Name:ODURO-AZIABOR, IRENE (NP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:ODURO-AZIABOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8088 HILLSIDE CLIMB WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-5777
Mailing Address - Country:US
Mailing Address - Phone:404-740-9048
Mailing Address - Fax:
Practice Address - Street 1:8088 HILLSIDE CLIMB WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-5777
Practice Address - Country:US
Practice Address - Phone:404-740-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227115363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health