Provider Demographics
NPI:1043075013
Name:ODI, HEZEKIAH
Entity type:Individual
Prefix:
First Name:HEZEKIAH
Middle Name:
Last Name:ODI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SPRINGVIEW CT
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8346
Mailing Address - Country:US
Mailing Address - Phone:443-848-4821
Mailing Address - Fax:
Practice Address - Street 1:504 SPRINGVIEW CT
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8346
Practice Address - Country:US
Practice Address - Phone:443-848-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9544319163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health