Healthcare Provider Details

I. General information

NPI: 1912453572
Provider Name (Legal Business Name): STELLA OKORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 PECONIC PLACE
UPPER MARLBORO MD
20774-5704
US

IV. Provider business mailing address

1011 PECONIC PL
UPPER MARLBORO MD
20774-5704
US

V. Phone/Fax

Practice location:
  • Phone: 240-463-9156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1038834
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: