Provider Demographics
NPI:1205227360
Name:ASANTE-ODAME, EVA
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:ASANTE-ODAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 TOWNSEND AVE APT 9B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7914
Mailing Address - Country:US
Mailing Address - Phone:845-659-0256
Mailing Address - Fax:
Practice Address - Street 1:1785 TOWNSEND AVE APT 9B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7914
Practice Address - Country:US
Practice Address - Phone:845-659-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320273164W00000X
NJ26NP06850300164W00000X
PAPN293906164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse