Healthcare Provider Details

I. General information

NPI: 1700338720
Provider Name (Legal Business Name): FIONA UZOAMAKA OKOROTI RN, APN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 N ALPINE RD
ROCKFORD IL
61114-4899
US

IV. Provider business mailing address

3650 N ALPINE ROAD
ROCKFORD IL
61114-4899
US

V. Phone/Fax

Practice location:
  • Phone: 815-877-7408
  • Fax: 815-877-9818
Mailing address:
  • Phone: 815-877-7408
  • Fax: 815-877-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.014957
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.014957
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: