Healthcare Provider Details

I. General information

NPI: 1679004899
Provider Name (Legal Business Name): ONYINYE OKOYE-EPUNDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S BROADWAY SUITE 18
MINOT ND
58701-4667
US

IV. Provider business mailing address

1015 S BROADWAY SUITE 18
MINOT ND
58701-4667
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-8500
  • Fax: 701-857-8555
Mailing address:
  • Phone: 701-857-8500
  • Fax: 701-857-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR42130
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberR42130
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: