Healthcare Provider Details

I. General information

NPI: 1659018919
Provider Name (Legal Business Name): ANTHONY ONYEISI OKADE NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 WESTER RD
RALEIGH NC
27604-4804
US

IV. Provider business mailing address

3916 WESTER RD
RALEIGH NC
27604-4804
US

V. Phone/Fax

Practice location:
  • Phone: 919-412-3586
  • Fax:
Mailing address:
  • Phone: 919-412-3586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07220851
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: