Individual provider Active NPI

Ekor Wonah Odaji, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Middletown, DE
National Provider Identifier
1215750609
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AN-0025824 Issued in DE
Practice address
12 Pennington St Ste 100
Middletown, DE 19709-1026
Phone
(302) 724-1181
NPI assigned
Nov 4, 2024
Last updated
Nov 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AN-0025824 DE Primary

Addresses

Primary practice location

12 Pennington St Ste 100
Middletown, DE 19709-1026

Mailing address

590 Red Maple Rd
Smyrna, DE 19977-5294
Phone (908) 370-2902

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1000 Smyrna Clayton Blvd
Suite 5
Smyrna, DE 19977-2228

35 Newgate Cir
Smyrn, DE 19977-4039

5632 Whitfield Chapel Rd
Apt 203
Lanham, MD 20706-2554

8201 Corporate Dr
Suite 630
Hyattsville, MD 20785-2258

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AN-0025824DEMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1215750609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 RED MAPLE RD",
            "city": "SMYRNA",
            "state": "DE",
            "postal_code": "199775294",
            "telephone_number": "908-370-2902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 PENNINGTON ST STE 100",
            "city": "MIDDLETOWN",
            "state": "DE",
            "postal_code": "197091026",
            "telephone_number": "302-724-1181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODAJI",
        "first_name": "EKOR",
        "middle_name": "WONAH",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-04",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "DE",
            "license": "AN-0025824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, DE

Sources for this page

Verify at the official NPI Registry.