MR. WASHINGTON ODHIAMBO MITEMA (NPI# 1154709798) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154709798 |
| Entity Type | Individual |
| Full Name | MR. WASHINGTON ODHIAMBO MITEMA |
| Credential | FNP |
| Practice Address |
1305 Us-377 Hwy Roanoke TX 76262 |
| Practice Telephone | 6828311923 |
| Mailing Telephone | (682) 831-1923 |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
724406 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TEXAS BOARD OF NURSING | 724406 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2716 Cedar Ridge Ln, Fort Worth, TX 761772111 | 6822340660 |
| Street Address |
1305 US-377 HWY |
| City | ROANOKE |
| State | TX |
| Zip Code | 76262 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861025611 | Freeform Chiropractic Trophy Club LLC | Chiropractor | 2240 Sh 114, Suite 650, Trophy Club, TX 76262 | 2020-02-20 |
| 1932748498 | Legacy Physical Therapy and Wellness | Physical Therapist | 351 N Byron Nelson Blvd, Suite 110, Roanoke, TX 76262 | 2020-01-02 |
| 1497399687 | Roanoke Foot & Ankle Institute, Pllc | Podiatrist | 351 W Byron Nelson Blvd, Suite 100, Roanoke, TX 76262 | 2019-10-31 |
| 1710470810 | Maria Guadalupe Madera | Dentist | 5000 Highway 114, Unit 130, Northlake, TX 76262 | 2018-06-13 |
| 1912414251 | 6 Day Dental Group - Roanoke, Pllc | Clinic/Center | 200 Tx-114, Roanoke, TX 76262 | 2018-01-09 |
| 1144746561 | Lone Star Neurosurgical Assistants | Physician Assistant | 1270 Casa Bella Ct, Westlake, TX 76262 | 2017-08-17 |
| 1710347562 | Randolph R West Dds Pllc | Dentist | 295 W. Byron Nelson Blvd, Ste 304, Roanoke, TX 76262 | 2016-03-07 |
| 1912367228 | Cvs Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 35 Arta Dr, Westlake, TX 76262 | 2016-02-29 |
| 1952760050 | Roanoke Dental Group,pc | Dentist | 1320 N Hwy 377 Suite 100, Roanoke, TX 76262 | 2016-02-17 |
| 1942683115 | Fatima Naurose Siraj | Dentist | 860 East Highway 114 Ideal Dental, Suite 200, Roanoke, TX 76262 | 2015-07-07 |
| Find all providers in zip 76262 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225638026 | Prasanti Pinnamaraju | Nurse Practitioner | 5324 Fox Ridge Rd, Roanoke, VA 24018-8754 | 2020-10-29 |
| 1912512856 | Jennifer Larson | Nurse Practitioner | 8325 Barrens Rd, Roanoke, VA 24019-6701 | 2020-09-08 |
| 1356953053 | Jamie Brackenrich | Nurse Practitioner | 6994 Dawnwood Rd, Roanoke, VA 24018-6839 | 2020-08-24 |
| 1164044608 | Denise Pollock | Nurse Practitioner | 6032 Matisse Ln, Roanoke, VA 24018-5335 | 2020-05-07 |
| 1538703061 | Erin Moyer Shinault | Nurse Practitioner | 3559 Meadowlark Rd, Roanoke, VA 24018-5007 | 2019-10-28 |
| 1972146421 | Amy Rose Gregor | Nurse Practitioner | 15645 Pioneer Bluff Trl, Roanoke, TX 76262-1799 | 2019-10-28 |
| 1811409402 | Victor Cisneros | Nurse Practitioner | 3535 Franklin Rd Sw, Roanoke, VA 24014-2255 | 2017-11-03 |
| 1053841965 | Christin Elledge Clark | Nurse Practitioner | 1234 Franklin Road, Roanoke, VA 24016 | 2017-06-13 |
| 1578009346 | Debra Jean Massaro | Nurse Practitioner | 123 Sesame St., Roanoke, VA 24011 | 2017-01-17 |
| 1407216831 | Keri Lynn Baker | Nurse Practitioner | 1 Riverside Cir Fl 4, Roanoke, VA 24016-4961 | 2016-02-26 |
| Find all providers in ROANOKE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.