Healthcare Provider Details

I. General information

NPI: 1598207060
Provider Name (Legal Business Name): MICHAEL OKOJIE NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 07/09/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CHERRY VALLEY RD
REISTERSTOWN MD
21136-3256
US

IV. Provider business mailing address

210 CHERRY VALLEY RD
REISTERSTOWN MD
21136-3256
US

V. Phone/Fax

Practice location:
  • Phone: 443-985-6547
  • Fax:
Mailing address:
  • Phone: 443-985-6547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR201291
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR201291
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351730
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14860600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: