Healthcare Provider Details

I. General information

NPI: 1457230542
Provider Name (Legal Business Name): SAMUEL CHINEDU OKOH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 W DUNLAP AVE APT 150
PHOENIX AZ
85021-2810
US

IV. Provider business mailing address

PO BOX 1716
LITCHFIELD PARK AZ
85340-1716
US

V. Phone/Fax

Practice location:
  • Phone: 520-688-6767
  • Fax:
Mailing address:
  • Phone: 520-688-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number260727
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: