Provider Demographics
NPI:1811246523
Name:ODOR, NKEMJIKA IRIS
Entity type:Individual
Prefix:
First Name:NKEMJIKA
Middle Name:IRIS
Last Name:ODOR
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 1:5 LANE LN
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-8630
Mailing Address - Country:US
Mailing Address - Phone:307-674-6878
Mailing Address - Fax:
Practice Address - Street 1:2920 N GREEN VALLEY PKWY STE 812
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0409
Practice Address - Country:US
Practice Address - Phone:702-861-1875
Practice Address - Fax:210-892-3616
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator