Healthcare Provider Details

I. General information

NPI: 1467285346
Provider Name (Legal Business Name): NOEL OKON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 CASTOR AVE STE B
PHILADELPHIA PA
19149-2100
US

IV. Provider business mailing address

6800 CASTOR AVE STE B
PHILADELPHIA PA
19149-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-8492
  • Fax:
Mailing address:
  • Phone: 215-745-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP030813
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15123700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: