Healthcare Provider Details

I. General information

NPI: 1861099384
Provider Name (Legal Business Name): LAURA N OKOLIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 RUIN CREEK RD
HENDERSON NC
27536-2932
US

IV. Provider business mailing address

381 RUIN CREEK RD
HENDERSON NC
27536-2932
US

V. Phone/Fax

Practice location:
  • Phone: 252-430-0666
  • Fax:
Mailing address:
  • Phone: 404-542-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10673
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: