Provider Demographics
NPI:1023824505
Name:ODURO, ALEXANDER (RN)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:ODURO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 RICHMOND HIGHWAY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2305
Mailing Address - Country:US
Mailing Address - Phone:571-345-4664
Mailing Address - Fax:703-768-3019
Practice Address - Street 1:7524 RICHMOND HIGHWAY
Practice Address - Street 2:SUITE 240
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-2305
Practice Address - Country:US
Practice Address - Phone:703-624-4317
Practice Address - Fax:703-768-3019
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA222447251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care