Healthcare Provider Details

I. General information

NPI: 1396149167
Provider Name (Legal Business Name): BENEDICTA OKOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 LOGAN WAY APT. A3
BLADENSBURG MD
20710-1816
US

IV. Provider business mailing address

6001 LOGAN WAY APT. A3
BLADENSBURG MD
20710-1816
US

V. Phone/Fax

Practice location:
  • Phone: 240-350-1443
  • Fax:
Mailing address:
  • Phone: 240-350-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN1005515
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: