Provider Demographics
NPI:1194492140
Name:ODHNER, ELIZABETH CLARA (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLARA
Last Name:ODHNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CLARA
Other - Last Name:DIEDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1309 W WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-2532
Mailing Address - Country:US
Mailing Address - Phone:608-692-2461
Mailing Address - Fax:
Practice Address - Street 1:2902 W CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4609
Practice Address - Country:US
Practice Address - Phone:623-455-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262994363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty