Healthcare Provider Details

I. General information

NPI: 1366319394
Provider Name (Legal Business Name): PRECIOUS OKWUSE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 ARSENAL ST
WATERTOWN NY
13601-2213
US

IV. Provider business mailing address

3983 LAKE NED VILLAGE CIR
WINTER HAVEN FL
33884-2586
US

V. Phone/Fax

Practice location:
  • Phone: 315-221-5289
  • Fax: 315-362-3839
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: