Provider Demographics
NPI:1083402424
Name:ODHIAMBO, MILLICENT (RN)
Entity type:Individual
Prefix:
First Name:MILLICENT
Middle Name:
Last Name:ODHIAMBO
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 TRANQUILITY LAKE BLVD APT 7206
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4687
Mailing Address - Country:US
Mailing Address - Phone:478-302-1772
Mailing Address - Fax:
Practice Address - Street 1:2800 TRANQUILITY LAKE BLVD APT 7206
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4687
Practice Address - Country:US
Practice Address - Phone:478-302-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011285163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse