Healthcare Provider Details

I. General information

NPI: 1164414512
Provider Name (Legal Business Name): HENRIETTA OBY OKPALA DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HENRIETTA OBY OKPALA NPP

II. Dates (important events)

Enumeration Date: 08/20/2005
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 CHURCH AVE STE E
BROOKLYN NY
11226-4209
US

IV. Provider business mailing address

10536 AVENUE K
BROOKLYN NY
11236-3018
US

V. Phone/Fax

Practice location:
  • Phone: 347-627-6100
  • Fax: 718-228-9641
Mailing address:
  • Phone: 718-763-9323
  • Fax: 718-763-6082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400707
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: