Provider Demographics
NPI:1730814260
Name:ODUM, HEIDI LISA (APRN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LISA
Last Name:ODUM
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:248 PLEASANT ST STE G300
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7530
Mailing Address - Country:US
Mailing Address - Phone:603-224-9995
Mailing Address - Fax:603-226-0859
Practice Address - Street 1:224 PLEASANT STREET, SUITE G300
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-224-9995
Practice Address - Fax:603-226-0859
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-09-07
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Provider Licenses
StateLicense IDTaxonomies
NH064437-23207RN0300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology