Healthcare Provider Details

I. General information

NPI: 1487620449
Provider Name (Legal Business Name): AGNES CHINYERE OKORO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 2ND AVE S STE 400
MINNEAPOLIS MN
55402-3318
US

IV. Provider business mailing address

9002 PEACH STONE CT
RICHMOND TX
77407-5095
US

V. Phone/Fax

Practice location:
  • Phone: 612-225-1512
  • Fax:
Mailing address:
  • Phone: 281-762-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number603924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: