Provider Demographics
NPI:1962031757
Name:ODOM, BRITTANY R (LVN)
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:R
Last Name:ODOM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 CLEMSON DR
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8126
Mailing Address - Country:US
Mailing Address - Phone:419-290-5991
Mailing Address - Fax:
Practice Address - Street 1:1520 CLEMSON DR
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154-8126
Practice Address - Country:US
Practice Address - Phone:419-290-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28327164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse