Provider Demographics
NPI:1386379899
Name:ODIPO, MARY S (LVN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:ODIPO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15019 PEOPLES DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5415
Mailing Address - Country:US
Mailing Address - Phone:210-748-8267
Mailing Address - Fax:
Practice Address - Street 1:15019 PEOPLES DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5415
Practice Address - Country:US
Practice Address - Phone:210-748-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309148164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse