Healthcare Provider Details

I. General information

NPI: 1407370240
Provider Name (Legal Business Name): EMEKA LINUS CHIKWELU OKAFOR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. LINUS EMEKA CHIKWELU OKAFOR

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 124TH CIR NW
COON RAPIDS MN
55433-1659
US

IV. Provider business mailing address

2608 87TH TRL N
BROOKLYN PARK MN
55443-3742
US

V. Phone/Fax

Practice location:
  • Phone: 763-222-4746
  • Fax: 763-888-0075
Mailing address:
  • Phone: 763-222-4746
  • Fax: 763-888-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number157754-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: