Provider Demographics
NPI:1578181970
Name:ODIETE, KAWAMEN LEVEY
Entity Type:Individual
Prefix:
First Name:KAWAMEN
Middle Name:LEVEY
Last Name:ODIETE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29325 SW 182ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3007
Mailing Address - Country:US
Mailing Address - Phone:786-371-6368
Mailing Address - Fax:
Practice Address - Street 1:29325 SW 182ND AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3007
Practice Address - Country:US
Practice Address - Phone:786-371-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-12
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily