Healthcare Provider Details

I. General information

NPI: 1609425842
Provider Name (Legal Business Name): GODSFAVOUR JOY OKON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 RIVERDALE RD APT 103
NEW CARROLLTON MD
20784-3928
US

IV. Provider business mailing address

7765 RIVERDALE RD APT 103
NEW CARROLLTON MD
20784-3928
US

V. Phone/Fax

Practice location:
  • Phone: 202-760-9564
  • Fax:
Mailing address:
  • Phone: 202-760-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14580
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: