Healthcare Provider Details

I. General information

NPI: 1346267770
Provider Name (Legal Business Name): EUNICE OKORO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BENJAMIN ADEUALE MD

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 CALAMO ST STE 105
SPRINGFIELD VA
22150-3500
US

IV. Provider business mailing address

PO BOX 8057
ALEXANDRIA VA
22306-8057
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8028
  • Fax: 703-569-8085
Mailing address:
  • Phone: 703-509-8028
  • Fax: 703-569-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR132487
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: