Healthcare Provider Details

I. General information

NPI: 1306074158
Provider Name (Legal Business Name): MARY U OKOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 RIVERWELL CIR E
HOUSTON TX
77083-7722
US

IV. Provider business mailing address

8815 RIVERWELL CIR E
HOUSTON TX
77083-7722
US

V. Phone/Fax

Practice location:
  • Phone: 713-825-4968
  • Fax: 281-879-1485
Mailing address:
  • Phone: 713-825-4968
  • Fax: 281-879-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number010703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: