Provider Demographics
NPI:1356161350
Name:OTIENO, EUCABETH ATIENO (RN)
Entity type:Individual
Prefix:
First Name:EUCABETH
Middle Name:ATIENO
Last Name:OTIENO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EUCABETH
Other - Middle Name:ATIENO
Other - Last Name:ORAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12329 NW 137TH TER
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-7255
Mailing Address - Country:US
Mailing Address - Phone:443-447-7082
Mailing Address - Fax:
Practice Address - Street 1:12329 NW 137TH TER
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-7255
Practice Address - Country:US
Practice Address - Phone:443-447-7082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9497010163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9497010OtherREGISTERED NURSE