Provider Demographics
NPI:1386949634
Name:ODHIAMBO, BIBIAN ANYANGO (APRN)
Entity type:Individual
Prefix:
First Name:BIBIAN
Middle Name:ANYANGO
Last Name:ODHIAMBO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5788
Mailing Address - Country:US
Mailing Address - Phone:206-320-4642
Mailing Address - Fax:206-320-7344
Practice Address - Street 1:29 HOSPITAL PLZ STE 502
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-348-7410
Practice Address - Fax:203-961-8488
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60186024363LA2200X
CT006906363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health