Healthcare Provider Details

I. General information

NPI: 1124704150
Provider Name (Legal Business Name): VIVIAN OKAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SMITH AVE N
SAINT PAUL MN
55102-2344
US

IV. Provider business mailing address

333 SMITH AVE N
SAINT PAUL MN
55102-2344
US

V. Phone/Fax

Practice location:
  • Phone: 651-454-0781
  • Fax:
Mailing address:
  • Phone: 651-454-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9774
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: