Healthcare Provider Details

I. General information

NPI: 1972841856
Provider Name (Legal Business Name): AYO OKORO FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14625 BALTIMORE AVENUE SUITE 327
LAUREL MD
20707
US

IV. Provider business mailing address

14625 BALTIMORE AVE STE 327
LAUREL MD
20707-4902
US

V. Phone/Fax

Practice location:
  • Phone: 301-256-8766
  • Fax:
Mailing address:
  • Phone: 301-256-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR140642
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR140642
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR140642
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: