Provider Demographics
NPI:1861512675
Name:ODIRI, BENEDICT CHUKWUMA (RN)
Entity type:Individual
Prefix:MR
First Name:BENEDICT
Middle Name:CHUKWUMA
Last Name:ODIRI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:880 QUITMAN DR E
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2076
Mailing Address - Country:US
Mailing Address - Phone:614-572-6792
Mailing Address - Fax:
Practice Address - Street 1:880 QUITMAN DR E
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2076
Practice Address - Country:US
Practice Address - Phone:614-572-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH322621163W00000X
OHCOA 15637-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse