Healthcare Provider Details

I. General information

NPI: 1710180963
Provider Name (Legal Business Name): GRACE OKON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HICKORY RD
PLYMOUTH MEETING PA
19462-1047
US

IV. Provider business mailing address

603 MYRTLE LN
NEW CUMBERLAND PA
17070-2860
US

V. Phone/Fax

Practice location:
  • Phone: 610-834-1122
  • Fax: 610-834-7525
Mailing address:
  • Phone: 717-938-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN558202
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: