Healthcare Provider Details

I. General information

NPI: 1215170238
Provider Name (Legal Business Name): CHRISTIAN OFU OKOKO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 TERRACE RD APT 202
EAST CLEVELAND OH
44112-2067
US

IV. Provider business mailing address

16000 TERRACE RD APT 202
EAST CLEVELAND OH
44112-2067
US

V. Phone/Fax

Practice location:
  • Phone: 216-761-6363
  • Fax:
Mailing address:
  • Phone: 216-761-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberRN 344992
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: