Healthcare Provider Details

I. General information

NPI: 1023751732
Provider Name (Legal Business Name): PATIENCE CHINENYE OKOLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 03/31/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 GA HWY 96
BONAIRE GA
31005-3300
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 478-988-5711
  • Fax:
Mailing address:
  • Phone: 478-788-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN234573
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: