Provider Demographics
NPI:1598060600
Name:ODIRI, GERTRUDE IFEOMA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GERTRUDE
Middle Name:IFEOMA
Last Name:ODIRI
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 1:880 QUITMAN DR E
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2076
Mailing Address - Country:US
Mailing Address - Phone:614-532-0748
Mailing Address - Fax:
Practice Address - Street 1:880 QUITMAN DR E
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2076
Practice Address - Country:US
Practice Address - Phone:614-532-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN143241164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse