Individual
JAQUANA ODOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
213 WOLCOTT AVE, SYRACUSE, NY 13207-1124
(315) 664-2143
Mailing address
213 WOLCOTT AVE, SYRACUSE, NY 13207-1124
(315) 664-2143
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
881153
NY
Other
Enumeration date
07/11/2024
Last updated
07/11/2024
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