Individual
FAHRETA ODOBASIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
8411 SENECA TPKE, NEW HARTFORD, NY 13413
(315) 624-8500
Mailing address
8411 SENECA TPKE, NEW HARTFORD, NY 13413-4912
(315) 624-8500
(315) 801-8391
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209.024510
IL
363LF0000X
Family Nurse Practitioner
2827419A
IN
363LF0000X
Family Nurse Practitioner
Primary
344471
NY
363LF0000X
Family Nurse Practitioner
4704380248
MI
363LF0000X
Family Nurse Practitioner
APRN.CNP.0030138
OH
Other
Enumeration date
06/04/2019
Last updated
09/08/2022
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