Provider Demographics
NPI:1194434282
Name:ODEN, BREYANA
Entity type:Individual
Prefix:
First Name:BREYANA
Middle Name:
Last Name:ODEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 NANTUCKETT DR APT 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3169
Mailing Address - Country:US
Mailing Address - Phone:419-705-1192
Mailing Address - Fax:
Practice Address - Street 1:4618 NANTUCKETT DR APT 7
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3169
Practice Address - Country:US
Practice Address - Phone:419-705-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker