Healthcare Provider Details

I. General information

NPI: 1255947867
Provider Name (Legal Business Name): RUTH OKWAJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HANOVER PL
MOUNT VERNON NY
10552-3807
US

IV. Provider business mailing address

624 HANOVER PL
MOUNT VERNON NY
10552-3807
US

V. Phone/Fax

Practice location:
  • Phone: 646-267-9421
  • Fax:
Mailing address:
  • Phone: 646-267-9421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number339464
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number870493
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: