MEDICARE: VIVIAN OKOYE PA-C

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	363A00000X	Physician Assistant	PAC1175	ND
2	207QA0505X	Adult Medicine Physician	085009865	IL

General Provider Information

NPI Number	:	1639864911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN OKOYE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 5210
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58206-5210
Country	:	US
Telephone Number	:	701-205-3000
Fax Number	:	701-732-2501

Provider Business Practice Location Address
First Line	:	3674 S WASHINGTON ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-5766
Country	:	US
Telephone Number	:	701-205-3000
Fax Number	:	701-732-2501

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

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	10/30/2025

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Directions to “ VIVIAN OKOYE PA-C” Practice Location

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