Healthcare Provider Details

I. General information

NPI: 1386299519
Provider Name (Legal Business Name): BLESSING OKOCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BLESSING AKHIMIENMHONA

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW UNIT 5A
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

110 IRVING ST NW UNIT 5A
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 240-581-0926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR187748
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: