Provider Demographics
NPI:1942722186
Name:ODURO, PETER O
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:O
Last Name:ODURO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:O
Other - Last Name:ODURO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAREGIVER
Mailing Address - Street 1:4999 KINGSHILL DR APT 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5534
Mailing Address - Country:US
Mailing Address - Phone:614-254-1877
Mailing Address - Fax:
Practice Address - Street 1:4999 KINGSHILL DR APT 104
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5534
Practice Address - Country:US
Practice Address - Phone:614-254-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide