Healthcare Provider Details

I. General information

NPI: 1013436534
Provider Name (Legal Business Name): STELLA CHIZOBA OKOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NORTH GREEN STREET
BALTIMORE MD
21043
US

IV. Provider business mailing address

5080 ILCHESTER ROAD
ELLICOTT CITY MD
21043
US

V. Phone/Fax

Practice location:
  • Phone: 443-695-0663
  • Fax:
Mailing address:
  • Phone: 443-695-0663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR150282
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: