Healthcare Provider Details

I. General information

NPI: 1619792272
Provider Name (Legal Business Name): ROSE CHINENYE OKORO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSE CHINENYE OKORO PMHNP-BC

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MACDADE BLVD
COLLINGDALE PA
19023-1927
US

IV. Provider business mailing address

168 CRUM CREEK DR
WOODLYN PA
19094-1907
US

V. Phone/Fax

Practice location:
  • Phone: 610-522-4506
  • Fax:
Mailing address:
  • Phone: 484-995-3354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP029806
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: