Healthcare Provider Details

I. General information

NPI: 1841978947
Provider Name (Legal Business Name): ANGELA ISI OKODUWA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 DRAKE AVE
ROSELLE NJ
07203-2217
US

IV. Provider business mailing address

719 DRAKE AVE
ROSELLE NJ
07203-2217
US

V. Phone/Fax

Practice location:
  • Phone: 908-423-9319
  • Fax:
Mailing address:
  • Phone: 908-423-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number26NR15328200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: