Healthcare Provider Details

I. General information

NPI: 1801594734
Provider Name (Legal Business Name): OBY THERESA OKOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 78TH ST
BLOOMINGTON MN
55420-1400
US

IV. Provider business mailing address

7332 2ND AVE S
RICHFIELD MN
55423-3101
US

V. Phone/Fax

Practice location:
  • Phone: 952-854-5034
  • Fax:
Mailing address:
  • Phone: 612-423-3907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022031528
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: