Healthcare Provider Details

I. General information

NPI: 1972788107
Provider Name (Legal Business Name): VICTORIA OKOLOGO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 GLENWOOD RD
BROOKLYN NY
11210-1150
US

IV. Provider business mailing address

2420 GLENWOOD RD 5F
BROOKLYN NY
11210-1150
US

V. Phone/Fax

Practice location:
  • Phone: 718-421-3623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number480198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: