Doctor Name: | MARIKO LEE ODHNER |
NPI Number: | 1073880621 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | NP37010 |
Business Practice Address: | 269 Union St Lynn, MA - 019011314 |
Business Phone Number: | 7815962502 |
Business Fax Number: | 7815963966 |
Mailing Address: | 325 Main St, MEDFORD |
State: | MA |
Postal Code: | 021556152 |
Phone Number: | 6175198246 |
Fax Number: | |
NPI Enumeration Date: | 11/28/2011 |
NPI Last Update Date: | 12/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | NP37010 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | RI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |