Healthcare Provider Details

I. General information

NPI: 1588222327
Provider Name (Legal Business Name): LINDA OBINWANNE OKORONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S BROAD ST
NEW ORLEANS LA
70119-7410
US

IV. Provider business mailing address

411 S BROAD ST
NEW ORLEANS LA
70119-7410
US

V. Phone/Fax

Practice location:
  • Phone: 504-827-2928
  • Fax:
Mailing address:
  • Phone: 504-827-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: