MEDICARE: WENDY OKOLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	779035	NY

General Provider Information

NPI Number	:	1487288924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY OKOLO

Provider Business Mailing Address
First Line	:	11932 201ST PL
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3814
Country	:	US
Telephone Number	:	347-664-2663
Fax Number	:

Provider Business Practice Location Address
First Line	:	11932 201ST PL
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3814
Country	:	US
Telephone Number	:	347-664-2663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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Directions to “ WENDY OKOLO ” Practice Location

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