Healthcare Provider Details

I. General information

NPI: 1497897128
Provider Name (Legal Business Name): EMMANUEL OKECHUKWU MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11870 TEVARE LN UNIT 2084
LAS VEGAS NV
89138-6505
US

IV. Provider business mailing address

11870 TEVARE LN UNIT 2084
LAS VEGAS NV
89138-6505
US

V. Phone/Fax

Practice location:
  • Phone: 702-210-2763
  • Fax:
Mailing address:
  • Phone: 702-210-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL I OKECHUKWU
Title or Position: PRESIDENT
Credential: MD
Phone: 702-210-2763