Healthcare Provider Details

I. General information

NPI: 1437694205
Provider Name (Legal Business Name): GLORIA EBERECHUKWU OKOYE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 ROCK HILL PKWY
LITHIA SPRINGS GA
30122-3657
US

IV. Provider business mailing address

632 ROCK HILL PKWY
LITHIA SPRINGS GA
30122-3657
US

V. Phone/Fax

Practice location:
  • Phone: 310-384-3058
  • Fax:
Mailing address:
  • Phone: 310-384-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN189783
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: