Healthcare Provider Details

I. General information

NPI: 1710461587
Provider Name (Legal Business Name): OLISADUMBI OKOH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 LANCASTER AVE
HAVERFORD PA
19041-1336
US

IV. Provider business mailing address

370 LANCASTER AVE
HAVERFORD PA
19041-1336
US

V. Phone/Fax

Practice location:
  • Phone: 610-896-4924
  • Fax: 610-896-1090
Mailing address:
  • Phone: 610-896-4924
  • Fax: 610-896-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN691521
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: