Healthcare Provider Details

I. General information

NPI: 1477738078
Provider Name (Legal Business Name): FAUSTINA UCHE OKOLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 DUNN CT
CLINTON MD
20735-2981
US

IV. Provider business mailing address

25 CHISHOLM LANDING CT
NORTH POTOMAC MD
20878-4232
US

V. Phone/Fax

Practice location:
  • Phone: 301-806-6095
  • Fax:
Mailing address:
  • Phone: 301-806-6095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR090957
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: