Provider Demographics
NPI:1629490222
Name:ODIMARA, URSULA N (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:N
Last Name:ODIMARA
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:N
Other - Last Name:AKUJOBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:11082 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-3511
Mailing Address - Country:US
Mailing Address - Phone:215-632-9040
Mailing Address - Fax:215-632-0610
Practice Address - Street 1:11082 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-3511
Practice Address - Country:US
Practice Address - Phone:215-632-9040
Practice Address - Fax:215-632-0610
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013474363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily