Healthcare Provider Details

I. General information

NPI: 1629787031
Provider Name (Legal Business Name): CALISTA OLUCHI OKORIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 SARGENT RD NE APT 101
WASHINGTON DC
20017-2825
US

IV. Provider business mailing address

5101 SARGENT RD NE APT 101
WASHINGTON DC
20017-2825
US

V. Phone/Fax

Practice location:
  • Phone: 202-602-9492
  • Fax:
Mailing address:
  • Phone: 202-602-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: