Individual
JACKIE ODISHOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12163 N 87TH DR, PEORIA, AZ 85345-4132
(623) 326-8282
Mailing address
12163 N 87TH DR, PEORIA, AZ 85345-4132
(623) 326-8282
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
05/13/2014
Last updated
05/13/2014
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