Healthcare Provider Details

I. General information

NPI: 1124304159
Provider Name (Legal Business Name): IJEOMA ADAMMA OKEKE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 PIONEER CT
EWING NJ
08628-3604
US

IV. Provider business mailing address

28 PIONEER CT
EWING NJ
08628-3604
US

V. Phone/Fax

Practice location:
  • Phone: 732-514-2150
  • Fax:
Mailing address:
  • Phone: 732-514-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00341200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: