MEDICARE: MRS. BEATRICE OBIAGELI OKPALA RN, BSC OPTOMETRY

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	163WH0200X	Home Health Registered Nurse	152741-030	WI

General Provider Information

NPI Number	:	1700074804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEATRICE OBIAGELI OKPALA RN, BSC OPTOMETRY

Provider Business Mailing Address
First Line	:	1742 STONEHAVEN DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-8907
Country	:	US
Telephone Number	:	608-834-6203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1742 STONEHAVEN DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-8907
Country	:	US
Telephone Number	:	608-834-6203
Fax Number	:

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

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/15/2007

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