Healthcare Provider Details

I. General information

NPI: 1205523578
Provider Name (Legal Business Name): PERPETUAL IFEOMA OKOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13108 SHINNECOCK DR
SILVER SPRING MD
20904-7319
US

IV. Provider business mailing address

13108 SHINNECOCK DR
SILVER SPRING MD
20904-7319
US

V. Phone/Fax

Practice location:
  • Phone: 516-322-5853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: