Healthcare Provider Details

I. General information

NPI: 1568006195
Provider Name (Legal Business Name): MRS. CORDELIA C OKAFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 N LINCOLN AVE
CHICAGO IL
60625-2316
US

IV. Provider business mailing address

8025 W LYONS ST UNIT B
NILES IL
60714-4124
US

V. Phone/Fax

Practice location:
  • Phone: 773-353-5047
  • Fax: 773-353-2406
Mailing address:
  • Phone: 224-595-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209018683
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: