Basic Information
| Provider Information | |||||||||
| NPI: | 1548702434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ODITA-HONNAH | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30575 BAINBRIDGE RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441392275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403686868 | ||||||||
| FaxNumber: | 4403686866 | ||||||||
| Practice Location | |||||||||
| Address1: | 464 RICHMOND ROAD | ||||||||
| Address2: | #102 | ||||||||
| City: | RICHMOND HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441432704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164863233 | ||||||||
| FaxNumber: | 2164863180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2016 | ||||||||
| LastUpdateDate: | 08/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.020190 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0197721 | 05 | OH | MEDICAID |