Provider Demographics
NPI:1427332956
Name:ODEMERHO, BENEDICTA I (FNP)
Entity type:Individual
Prefix:MS
First Name:BENEDICTA
Middle Name:I
Last Name:ODEMERHO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5800 GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2426
Mailing Address - Country:US
Mailing Address - Phone:618-468-6800
Mailing Address - Fax:618-468-7410
Practice Address - Street 1:5800 GODFREY RD
Practice Address - Street 2:FOBES 1525
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2426
Practice Address - Country:US
Practice Address - Phone:618-468-6800
Practice Address - Fax:618-468-7410
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009075363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine