Healthcare Provider Details

I. General information

NPI: 1013561216
Provider Name (Legal Business Name): OSARETIN OKORO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ELLIOTT AVE W BAY AVE
SEATTLE WA
98119-4236
US

IV. Provider business mailing address

100 N HOWARD ST STE W
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 806-231-0116
  • Fax:
Mailing address:
  • Phone: 806-231-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP142728
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61396213
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: