Healthcare Provider Details

I. General information

NPI: 1750821070
Provider Name (Legal Business Name): CHRISTOPHER CHIDI OKALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7506 GEORGIA AVE NW
WASHINGTON DC
20012-1608
US

IV. Provider business mailing address

7506 GEORGIA AVE NW
WASHINGTON DC
20012-1608
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-6973
  • Fax: 202-291-7018
Mailing address:
  • Phone: 202-291-6973
  • Fax: 202-291-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1029201
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR210938
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: