Doctor Name: | MRS. LANISSA DANIELLE ODOR |
NPI Number: | 1083056386 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 17722 |
Business Practice Address: | 2085 Goodman Rd W Suite 50 Horn Lake, MS - 386371416 |
Business Phone Number: | 6622538459 |
Business Fax Number: | 6622538678 |
Mailing Address: | 2085 Goodman Rd W, Suite 50 HORN LAKE |
State: | MS |
Postal Code: | 386371416 |
Phone Number: | 6622538459 |
Fax Number: | |
NPI Enumeration Date: | 07/27/2013 |
NPI Last Update Date: | 12/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 17722 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |