Provider Demographics
NPI:1154639235
Name:ODOLE, COMFORT FUNMILAYO (RN)
Entity type:Individual
Prefix:
First Name:COMFORT
Middle Name:FUNMILAYO
Last Name:ODOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:FUNMILAYO
Other - Middle Name:MERCY
Other - Last Name:TEBEBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1705 LANDING ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4477
Mailing Address - Country:US
Mailing Address - Phone:347-285-1631
Mailing Address - Fax:
Practice Address - Street 1:1705 LANDING ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4477
Practice Address - Country:US
Practice Address - Phone:347-285-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX907355163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse