Provider Demographics
NPI:1669217964
Name:ODILI, CLARA IFEYINWA (NP)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:IFEYINWA
Last Name:ODILI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 E STACY RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8763
Mailing Address - Country:US
Mailing Address - Phone:817-726-6122
Mailing Address - Fax:
Practice Address - Street 1:596 E STACY RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8763
Practice Address - Country:US
Practice Address - Phone:817-726-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1159620363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner