Healthcare Provider Details

I. General information

NPI: 1295502060
Provider Name (Legal Business Name): CHUKWUDI VICTOR OKOLIE APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 S UNION AVE
TACOMA WA
98409-3317
US

IV. Provider business mailing address

917 PACIFIC AVE STE 600
TACOMA WA
98402-4437
US

V. Phone/Fax

Practice location:
  • Phone: 253-844-4327
  • Fax:
Mailing address:
  • Phone: 253-844-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ14971100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: